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PubMed1982

Ruptured abdominal aortic aneurysms presenting as radicular compression syndromes.

Two patients are described: one with an aneurysm of the infrarenal aorta and common iliac artery that ruptured posteriorly into the iliac vein, the other with an aneurysm of the distal abdominal aorta that ruptured posteriorly into the iliopsoas muscle. Both patients had symptoms compatible with a radicular compression syndrome. Ruptured aneurysm of one of the major abdominal arteries should be considered in the differential diagnosis of affections of the lumbosacral neural outflow, because immediate operation can be life-saving.

Aorta, Abdominal↗
PubMed1987

Central distribution of efferent and afferent components of the pudendal nerve in rat.

Central distribution of efferent and afferent components of the pudendal nerve was examined in the rat by the horseradish peroxidase (HRP) method after HRP application to the central cut end of the pudendal nerve. The pudendal motoneurons were located in the dorsolateral, dorsomedial and lateral groups at L5 and L6. Each of the dorsolateral and dorsomedial groups constituted a slender longitudinal cell column. Pudendal motoneurons in the lateral group were scattered at L5, rostrodorsally to the dorsolateral group. The neurons in the dorsolateral and lateral groups were labelled with HRP applied to the nerve branch innervating the ischiocavernosus and sphincter urethrae muscles. The neurons in the dorsomedial group were labelled with HRP applied to the branch supplying the sphincter ani externus and bulbospongiosus muscles. Some dendrites of pudendal motoneurons in the dorsomedial group extended to the contralateral dorsomedial group. These crossing dendrites were observed not only in male rats but also in female. The average number of the pudendal motoneurons in the dorsolateral and dorsomedial groups were larger in male rats than in female. A few neurons of the intermediolateral nucleus at upper L6 were also labelled with HRP applied to the dorsalis penis (clitoridis) nerve. Axon terminals of the pudendal nerve were distributed, bilaterally with an ipsilateral predominance, to the gracile nucleus, as well as to the dorsal horn and dorsal commissural gray from L4 to S2. A few labelled axons were seen in the intermediolateral nucleus at L6 and S1. Axon terminals from the dorsalis penis nerve were distributed more medially in the dorsal horn than those from the perinealis nerve.

Animals↗
PubMed1975

Preganglionic C-fibres: a major component of the sacral autonomic outflow to the colon of the cat.

The sacral preganglionic pathways to the colon and urinary bladder of the cat were studied with electrophysiological techniques. Peak conduction velocities in preganglionic fibres to the colon ranged from 0.5 to 1.4 m/sec, whereas maximum velocities in the bladder pathway were between 8 to 10 m/sec. Thresholds for electrical stimulation of preganglionic axons to the colon were 7 to 10 times higher than thresholds for bladder efferents. It is concluded that the sacral parasympathetic inputs to the colon and bladder are composed, respectively, of non-myelinated and myelinated fibres.

Animals↗
PubMed1994

Laparoscopic identification of preperitoneal nerve anatomy in the inguinal area.

The laparoscopic approach has recently been utilized for inguinal hernia repair. Nerve injuries are now being reported. The femoral branch of the genitofemoral nerve and the lateral cutaneous nerve of the thigh appear most at risk. The purpose of this study was to determine the feasibility of identifying these nerves laparoscopically on either a routine or selective basis. Twenty patients scheduled for laparoscopic inguinal hernia repair were prospectively selected. An attempt was made to identify these nerves so that optimum placement of staples could occur. The femoral branch of the genitofemoral nerve was identified in 19 of 20 patients and the lateral cutaneous nerve of the thigh in 18 of 20 patients. A review of 125 laparoscopic inguinal hernia repairs revealed five nerve injuries (4%). Details are given and recommendations discussed. Knowledge of preperitoneal anatomy and awareness of the location of these nerves should lead to a safer dissection and more accurate application of staples, hopefully decreasing the incidence of nerve injury.

Adult↗
PubMed1975

[Urologic complications in rectal surgery (author's transl)].

Urinary disorders after amputation or resection of the rectum are much more frequent than commonly supposed. Out of 239 patients they were noticed by 56.6%, undergoing amputation, and 36.6% after resection. Longterm disturbances were observed by 26.4% respect. 15.1%. The most important reason is injury of autonomic pelvic nerves and ganglia. Urinary bladder infection was verified in 22% respect. 8%. Furthermore urinary disorders may be caused by changing of bladder localization (bladder hernia), wound infection (especially of the sacral cavity), edema of the urethra, and exacerbation or manifestation of pre-existing urologic diseases. Compared to these, lesions of the urinary tract are of little importance. To prevent such complications, we postulate: 1. careful pre-operative urologic examination, 2. if possible mobilisation of the rectum along its borderlines (so-called Grenzlamellen of Pernkopf), 3. critical analysis of urologic disorders, removal of the urinary catheter as soon as possible, regular systemic prophylaxis of urinary infection, and therapy controlled by antibiogram, 4. adequate follow-up, and 5. urologic examination of all disturbances lasting longer than three months.

Age Factors↗
PubMed1997

The sensory innervation of the hip joint--an anatomical study.

Typically obturator nerve blockade is used to relieve hip pain. It sometimes only has a minor effect in resolving symptoms. This clinical observation led us to examine comprehensively the sensory nerve innervation of formalin-fixed hip joint capsules. Following macroscopic preparation, the area of the hip joint capsule was inspected with the aid of an operating microscope. We discovered a separation between the anterior and posterior sensory innervation of the hip joint capsule. The anteromedial innervation was determined by the articular branches of the obturator n. Additionally, the anterior hip joint capsule was innervated by sensory articular branches from the femoral n. In the posterior part we found articular branches from the sciatic n., which in addition to the articular branches from the nerves to the quadratus femoris m., innervate the postero-medial section of the hip joint capsule. Moreover, articular branches of the superior gluteal n. were found, which innervate the posterolateral section of the hip joint capsule. This anatomical study demonstrates that the obturator n. block is insufficient for the treatment of hip pain. Further investigations will determine if these nn. can be reached percutaneously. Effective neural blockade of the hip joint must include the femoral n., the sciatic n. and the superior gluteal n.

Femoral Nerve↗