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Results for “Autonomous surgery”

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PubMed2003

[The DREZ lesion as an effective treatment for chronic hypothetically post-herpetic neuropathic pain. Case report and review of literature].

The authors present a case of a 54-year-old woman with a 3-year history of chronic pain syndrome, probably of postherapeutic origin, with diffuse segmentary dermatome characteristics, both somatic and autonomic. The former were exemplified by a constant "burning" skin pain in the representation of Th8-LI dermatomes unilaterally, while the latter by a unilateral visceral pain within the abdominal cavity. Electrophysiological examination indicated a neuropathic origin of the pain, despite the lack of clinically evident sensory deficits and/or hypersensitivity. The pain was so intense that normal walking was difficult for the patient and ineffectiveness of her treatment made her suicidal. Since both pharmacological treatment (non-steroid analgesics, opioids, antidepressants, and anticonvulsants including gabapentin) and minimally invasive methods of treatment (blockades, thermolesions) failed to control pain, she was subjected to surgery. A right-sided DREZ lesion within the Th8-LI dermatomes resulted in a complete pain relief, both within the somatic and autonomic innervation projections, and in the patient's functional recovery.

Chronic Disease↗

PubMed2006

[Total mesorectal excision and preservation of autonomic nerves].

The procedure of total mesorectal excision (TME) becomes a gold standard for the treatment of rectal cancer. The reason is the marvelously low incidence of local recurrence after TME even without other adjuvant treatment, which has been reported by several independent groups. Although controversy still exists about the role of TME in upper rectal cancer, it is now widely accepted for cancers of the middle and lower third. There are number of histopathological evidences that cancer cells can spread distally several centimeters from the lower margin of cancer, and cancer bearing lymph nodes are found in the distal portion of the mesorectal tissues far from the cancer. Therefore, the distal clearance of mesorectum should be performed downwardly to the level of pelvic diaphragm (puborectalis) and the rectum is divided within a few centimeters from the pelvic floor musculature. TME defines an en-bloc procedure, along the plane between parietal and visceral pelvic fasciae. If the dissection plane is breached, the chance of visceral pelvic fascia tearing is raised and mesorectal tissue might reside in the pelvis. There are problems in auditing the procedure. As many surgeons agree, this procedure requires a learning curve. Theoretically, the autonomic nerves run between the visceral and parietal pelvic fasciae since the nerves must be preserved to make visceral fascial envelop. Any patient who become incontinent or impotent after the surgery should have received decorticating surgery other than TME. Thus, the high quality of TME should fulfill two clinical measurements: absence of impotence or incontinence and at least single digit, 5-year, cumulative recurrence rate regardless of adjuvant therapy.

Autonomic Pathways↗

PubMed1983

Potential preservation of potency after radical prostatectomy.

Radical prostatectomy often is followed by erectile dysfunction. Various etiologies have been postulated--vascular, psychologic, or neurologic. Recently, we were able to isolate the cavernous nerves of the prostatic plexus, which innervate the erectile tissue of the corpora cavernosa, for electroerection in dogs. Acute and chronic experiments were then performed to examine the relationship between erectile impotence and radical prostatectomy. We conclude that erectile impotence after total prostatectomy is a result of injury to the cavernous nerves and that potency can be preserved if these nerves are identified and salvaged during surgery.

Animals↗

PubMed2004

Inflammatory changes secondary to postoperative complications of Hirschsprung's disease as a cause of histopathologic changes typical of intestinal neuronal dysplasia.

PURPOSE: The aim of this study was to clarify the pathogenesis of intestinal neuronal dysplasia (IND). METHODS: The bowel habits of 36 postoperative HD patients were assessed retrospectively. Twenty-five had no complaints. Seven had persistent enterocolitis and were the focus of our study. They were divided into group A (n = 2) if they were severe and had associated postoperative surgical complications, and group B (n = 5) if they were mild. The histological changes were assessed. RESULTS: The 7 patients who had persistent enterocolitis postoperatively had no AchE activity in the mucosa, and there was normal distribution of submucosal and myenteric ganglia in the proximal resection margin. Rectal biopsies performed postoperatively for investigation of persistent enterocolitis in group A showed inflammatory changes and typical histopathologic features of IND such as abundant acetylcholinesterase (AchE)-positive nerve fibers in the lamina propria associated with giant submucosal ganglia and hyperganglionosis, and in group B there was increased AchE activity without hyperganglionosis or giant ganglia. CONCLUSIONS: This is the first report of histopathologic changes typical of IND occurring in response to persistent enterocolitis related to postoperative complications of surgery for HD.

Acetylcholinesterase↗

PubMed2002

[Postoperative nausea and vomiting--pathophysiology, prophylaxis and treatment].

Postoperative nausea and vomiting (PONV) are among the most common complications in operative medicine. Especially patients undergoing middle ear surgery or adenotonsillectomy are frequently associated with PONV (70 %). Furthermore, emesis carries the risk of severe postoperative complications and is associated with additional costs and distress in patient management. If the patient carries a high risk for postoperative emesis, the patient should receive a prophylactic antiemetic therapy. 5-HT 3 receptor antagonists are highly effective in prevention and management of PONV. This review will discuss pathophysiology, prophylaxis and treatment of postoperative nausea and vomiting after E.N.T. surgery.

Anesthetics↗

PubMed2001

Exploring factors influencing Chinese women's decision to have elective caesarean surgery.

OBJECTIVES: to identify the factors that influence Hong Kong Chinese women's decision to have an elective caesarean section. To explore Chinese women's perceptions of their autonomous involvement in childbirth decision-making. DESIGN: a qualitative exploratory design. SETTING: a postnatal ward of a private hospital in Hong Kong. PARTICIPANTS: a purposive sample of six postnatal women who had undergone an elective caesarean section. FINDINGS: four thematic categories were identified including: avoiding fetal and maternal risks, exercising autonomy to make an independent choice, Chinese belief systems, and rejoicing and regretting. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: we propose the provision of a 'named' midwife and continuity of care. Improving the availability of information on caesarean sections, accommodating a Chinese belief system in the planning of midwifery services at the international level and establishing post caesarean section peer support groups are recommended.

Adult↗

PubMed1977

Retrograde degeneration of autonomic neurons and other cell groups of the spinal cord following extirpation the thoracic sympathetic ganglia.

Examination of vegetative, as well as sensitive and motor spinal neurons after surgery performed on the peripheral part of the vegetative nervous system in the thoracic cavity of 34 dogs reveals reactive and degenerative changes in the nerve cells. Alterations in the neuronal structure are already observed on the 7th day after the operation and they reach thir maximum on the 60th day. During the time mentioned, most of the nervous cells undergo a complete pyknosis; among them, however, there are neurons restoring their normal structure. Therefore, it is possible to believe that after operations on the thoracic cavity, certain morphological disturbances occur in the corresponding vegetative centers, which are followed by disorders in the nervous regulation of the internal organs after the operation.

Animals↗

PubMed2001

[Adrenocortical macronodular hyperplasia with massive enlargement of the gland. A rare variant of autonomous hypercortisolism].

OBJECTIVE: To present a case of Cushing's syndrome due to massive adrenocortical macronodular hyperplasia that gave the gland the appearance of a pseudotumor. METHODS: In a review of the surgical pathology of the adrenal gland recently performed in our hospital, 82 adrenalectomy specimens obtained from 1978-1998 were found. Of these 82 surgical specimens, 44 (53.6%) were cortical pathologies and 10 of these (12.1%) were hyperplasia. There was only one with massive adrenocortical macronodular hyperplasia. A 53-year-old male, chronic alcoholic with cushingoid obesity and hypercortisolism is described. RESULTS: Ultrasound and CT assessment showed enlarged, asymmetrical adrenal glands and macronodules. The analytical and MRI study of the sella turcica showed primary adrenal hypercortisolism. Adrenalectomy of the dominant gland (the left adrenal whose activity was demonstrated on the 131Iodine scintiscan) was performed. The postoperative cortisol levels returned to normal and remain normal up to the present time, 18 months after surgery. The surgical specimen weighed 104 gms and was completely macronodular. CONCLUSIONS: Massive adrenocortical macronodular hyperplasia is a rare cause of pituitary-independent autonomous primary adrenal hypercortisolism. It is always bilateral. Adrenal weight is significantly increased (total weight of both adrenals 60-180 gms) and present yellow or golden, non-encapsulated nodules of a few millimeters to up to 4 cms, comprised of cells with scanty activity, therefore massive enlargement of the glands is necessary to produce Cushing's syndrome. The clinical, biochemical and surgical aspects can cause confusion and can be suggestive of an adrenocortical neoplasm. Treatment is by adrenalectomy.

Adrenal Cortex↗

PubMed1999

[Does method of anesthesia modify postoperative ischemia incidence? A study of patients after aortocoronary bypass operations].

In the postoperative period after coronary artery bypass graft surgery, the physician's enhanced attention should be focused on the incidence of myocardial ischaemia. The increased stress in the awakening patient as well as the return of autonomous reflexes can be the cause of imbalances in myocardial oxygen supply and uptake. Therefore, a probable influence of the pharmacologic profile of the intraoperatively applied anaesthetics on the incidence of postoperative myocardial ischaemia is of importance for adapting therapy on ICU to minimize any ischaemic risk. After approval by the ethics committee, a prospective randomized study was performed in 40 male patients who underwent coronary artery bypass graft surgery. The aim of the study was to compare balanced anaesthetic techniques performed with fentanyl and halothane, isoflurane and enflurane, respectively, with total intravenous anaesthesia performed with fentanyl and midazolam. An index to classify detection of ischaemia into three categories (ischaemia, probable ischaemia, no ischaemia) was established, based on measurements of myocardial lactate extraction and ST-segment analysis. Simultaneously, measurements of haemodynamic parameters and serum concentrations of catecholamines and intraoperatively applied anaesthetics were taken. In 8% of all measurements (30% of all patients) ischaemia was detected in the observation period and in 37% of all measurements (72.5% of all patients) probable ischaemia was detected. No significant difference was found concerning the incidence of myocardial ischaemia between all groups. The results of this investigation indicate that the application of inhalational anaesthetics for maintaining anaesthesia in coronary artery bypass graft surgery does not increase the risk of postoperative myocardial ischaemia.

Adult↗

PubMed2005

Systemic administration of cholera toxin B subunit conjugated to horseradish peroxidase in the adult rat labels preganglionic autonomic neurons, motoneurons, and select primary afferents for light and electron microscopic studies.

Retrograde and transganglionic labeling techniques are commonly used to visualize subsets of neurons and sensory afferent projections in the nervous system. These methods commonly require anesthesia and surgical methods. However, some tracers can also be administered systemically in awake animals, thus reducing risks associated with anesthesia and surgery and allowing for labeling of neuronal populations that are difficult to label with local tracer injections. Here, we demonstrate in the adult rat that intraperitoneal administration of cholera toxin subunit B conjugated to horseradish peroxidase labels preganglionic autonomic neurons, motoneurons, and the terminal projections of select primary afferents for both light and electron microscopic studies. We demonstrate also that this method can be combined with post-embedding immunogold labeling to detect amino acid transmitters in synaptic boutons.

Animals↗

PubMed1979

Hypertension and aldosterone overproduction without renin suppression in Cushing's syndrome from an adrenal adenoma.

Adrenal steroids and compenents of the renin-angiotensin system were measured before and after adrenalectomy in a woman with Cushing's syndrome and hypertension from a functioning adrenocortical adenoma. Aldosterone, deoxycorticosterone and cortisol were produced in excess by the adenoma, and were measured in tumor tissue. High plasma renin substrate concentrations, and normal basal and furosemide-stimulated plasma renin activities and plasma renin concentrations which were present before surgery, decreased after adrenalectomy, and the hypertension diminished. The inappropriately normal levels of renin and potassium in this patient, despite autonomous aldosterone overproduction, suggest an ineffective mineralocorticoid action of aldosterone, possibly from interaction with her other adenoma-produced steroids. The decrease in components of the renin-angiotensin system suggests a partial renin-dependence of her hypertension.

Adenoma↗

PubMed1986

Physiological and subjective stress responses in surgical patients.

Autonomic responses, mood and psychological coping were assessed in two groups of orthopaedic patients during hospitalisation for major or minor surgery. Eight patients admitted for total hip replacement and seven patients undergoing knee arthroscopy were seen daily for two days before surgery until discharged from hospital. Mood and coping questionnaires were administered on each session, while pain, heart rate, blood pressure, skin conductance level, palmar sweat prints and forearm EMG were also recorded. Heart rate increased from pre- to post-operative assessments, while skin conductance and palmar sweating fell to low levels on the days immediately following surgery, returning to basal values only after several days. Self ratings of anxiety, fatigue, depression and pain were highest on the immediate post-operative days. Patients utilised the coping factors Rational Cognition and Behavioural Action to the greatest extent, but ratings on coping factors fluctuated little over the study period. The interrelations between these measures and possible explanations of the results are discussed.

Adaptation, Psychological↗

PubMed1995

Insulinoma: pitfalls in preoperative localization.

In patients with biochemical evidence of insulinoma, many techniques have been advocated as the procedures of choice for diagnostic localization without a clear-cut consensus as to their utility. Despite the small size of insulinomas, 90% are solitary and nearly 100% are intrapancreatic. A commonly held belief is that once the diagnosis of autonomous hyperinsulinism is confirmed, it is necessary to secure as much information as possible about the precise location prior to surgery. Although frequently used, preoperative localization studies are expensive, potentially morbid, and worse yet, may be misleading. We present a case study in which the preoperative studies falsely localized the insulinoma to the pancreatic head. Since the introduction of intraoperative ultrasound (IOUS), it is now unusual not to identify and excise the insulinoma in patients undergoing exploration for functioning beta-islet cell lesions. Our experience, along with support from the literature, led us to recommend a simplified localization approach, namely IOUS combined with surgical palpation.

Female↗

PubMed1998

Mitochondrial genomic markers confirm the presence of the camel strain (G6 genotype) of Echinococcus granulosus in north-western China.

Twenty-eight isolates of E. granulosus, collected from humans at surgery, and a range of intermediate hosts, including sheep, cattle and camels from abattoirs in North and South Xinjiang Uygur Autonomous Region, People's Republic of China, were analysed for DNA sequence variation within regions of the mitochondrial cytochrome c oxidase I (COI) and NADH dehydrogenase subunit I (NDI) genes. The isolates were categorized into 2 distinct and uniform genotypic groupings, based on the sequences obtained, and the data clearly indicated that the camel/dog strain (G6 genotype) of E. granulosus as well as the cosmopolitan, common sheep strain (G1 genotype) occur in north Xinjiang. The presence of the camel strain has thus been confirmed in Xinjiang but it is evident from this and a previous molecular genetic survey of E. granulosus isolates from north-western China that the common sheep strain is the most predominant in the region. From the public health perspective, the majority of infected livestock will act as reservoirs of human infection there. During the course of the study, a polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) assay, based on the NDI sequence variation, was developed that allows rapid discrimination of the G1 and G6 genotypes.

Animals↗

PubMed1996

[Attempt at a definition of the individual anesthesia level by repetitive pain stimulation: correlation with EEG findings].

AIM: Previous studies using EEG for assessment of depth of anaesthesia correlate anaesthetic concentration with the anaesthetic stage. This procedure neglects the well known effect of individual different susceptibility to anaesthetics. Thus, patients receiving similar concentrations of anaesthetics may not necessarily be at the same level of "anaesthetic depth". The aim of this study was to define an interindividual comparable level of anaesthesia by recording the autonomic cardiovascular reaction to a standardised painful stimulus (tetanic stimulus, 80 mA, 100 Hz). METHODS: In 61 patients undergoing orthopaedic surgery general anaesthesia was performed with isoflurane in 66% N2O. Starting from 0.4% isoflurane, endtidal isoflurane concentration was increased in a stepwise manner (0.1% isoflurane) until the patient did not show any relevant cardiovascular reaction (increase of heart rate and/or blood pressure < 10%) after tetanic stimulation of the ulnar nerve. If patients demonstrated no haemodynamic changes at 0.4% isoflurane, the concentration was decreased until a relevant cardiovascular reaction was registered. During each steady state period multichannel EEG was recorded and mean values of power density (median: microV2/Hz) were computed. RESULTS: Comparing EEG-results between both groups exhibiting a cardiovascular reaction (CVR+ , median endtidal Iso: 0.5%) and without reaction (CVR- , median endtidal Iso: 0.6%) an increase in low frequency bands and a significant decrease in high frequencies was found (Wilcoxon-test, p < 0.05). In contrast, comparing EEG-data only in relation to endtidal isoflurane concentration neglecting individual haemodynamic responses, no differences of power density in high frequency bands were detected. CONCLUSION: This method to define individual depth of anaesthesia as described, results in more consistent EEG patterns and may be useful in relating EEG to depth of anaesthesia.

Adult↗

PubMed1995

Low vagal tone and supraventricular ectopic activity predict atrial fibrillation and flutter after coronary artery bypass grafting.

To investigate the impact of pre-operative autonomic balance and atrial ectopic activity on the risk of atrial fibrillation or flutter after aorto-coronary artery bypass surgery 24-h Holter monitoring was analysed in 102 patients before coronary artery bypass grafting. Index for vagal tone was calculated as % successive RR interval differences > 6%. Twenty-nine (28%) of the 102 patients developed atrial fibrillation or flutter. Independent predictors (90% confidence interval) of postoperative atrial fibrillation or flutter were identified by logistic regression analysis: the independent predictors were older age, relative risk 1.07.year-1 (1.02-1.12), vagal index < 10%, relative risk 4.50 (1.40-14.5), > or = 10 ectopic supraventricular beats . 24 h-1, relative risk 3.03 (1.05-8.72), and one or more events of non-sustained supraventricular tachycardia, relative risk 3.02 (1.11-8.22). Thus, age of the patient, attenuated pre-operative cardiac vagal modulation, ectopic supraventricular beats, and paroxysmal non-sustained supraventricular tachycardia are independent risk factors for the development of atrial fibrillation or flutter after coronary artery bypass surgery.

Adrenergic beta-Antagonists↗

PubMed2006

Female urogenital dysfunction following total mesorectal excision for rectal cancer.

BACKGROUND: The effect of Total Mesorectal Excision (TME) on sexual function in the male is well documented. However, there is little literature in female patients. The aim of this study was to review the pelvic autonomic nervous anatomy in the female and to perform a retrospective audit of urinary and sexual function in women following surgery for rectal cancer where TME had been performed. Urogenital dysfunction was assessed through interview and questionnaire. METHOD: Twenty-three questionnaires, eighteen returned, were sent to women with a mean age 65.5 yrs (range 34-86). All had undergone total mesorectal excision for rectal cancer between 1998-2001. Mean follow-up was 18.8 months (range 3-35). RESULTS: Preoperatively 5/18 (28%) were sexually active, 3/18 (17%) of patients described urinary frequency and nocturia and 7/18 (39%) described symptoms of stress incontinence prior to surgery. Postoperatively all sexually active patients remained active although all described some discomfort with penetration. Two of the patients sexually active described reduced libido secondary to the stoma. Postoperative urinary symptoms developed with 59% reporting the development of nocturia, 18% developed stress incontinence and one patient required a permanent catheter. Of those with symptoms, 80% persisted longer than three months from surgery. Symptoms were predominant in those patients with low rectal cancers, particularly those undergoing abdomino-perineal excision and in those who had previously undergone abdominal hysterectomy. CONCLUSION: The treatment of rectal cancer involves surgery to the pelvic floor. Despite nerve preservation this is associated with the development of worsening nocturia and stress incontinence. This is most marked in those patients who had previously undergone a hysterectomy. Further studies are warranted to assess the interaction with previous gynaecological surgery.

Journal Article↗

PubMed1999

[Total excision of the mesorectum and preservation of the genitourinary innervation in surgery of rectal cancer].

Locoregional recurrence is one of the most important problems after surgery for rectal cancer. Four to five per cent local recurrence rates have been reported after total mesorectal excision with autonomic nerve preservation. After an anatomic description, the authors describe the surgical technique of total mesorectal excision with nerve preservation. Carcinologic and functional results are reported, before concluding that this technique should be performed for mid or low rectal tumours with a distance to anorectal junction less than 5 cm.

Autonomic Nervous System↗