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At least 811 records · Page 45Linked to original sources
PubMed2002

Upper sympathetic trunk lesion after video-assisted fracture stabilization of the thoracic spine: a case report.

This case report draws attention to the upper sympathetic trunk lesion as a complication of video-assisted thoracic spine surgery. A 39-year-old man developed an upper sympathetic trunk lesion after right-sided thoracoscopic fracture stabilization of T5 and T6. Dizziness and reduced perspiration persisted at the most recent follow-up 8 months after surgery. This rare complication can be overlooked and remain undiagnosed. Diagnosis is based on clinical symptoms and neurologic examination. There are no treatment options. Symptoms can be bothersome for the patient and may persist. In the upper thoracic spine, the course of the sympathetic trunk lies in close proximity of the vertebral bodies; thus, care must be taken to avoid it when resecting the posterior parts of the vertebral body.

Adult↗
PubMed1996

Pelvic autonomic nerve preservation for patients with rectal carcinoma. Oncologic and functional outcome.

BACKGROUND: Serious problems in the surgical treatment of patients with rectal carcinoma are local failure and urinary and sexual dysfunction. To resolve these problems, pelvic autonomic nerve preservation (PANP) combined with lateral lymph note dissection has been introduced. METHODS: Of 238 consecutive patients with middle or low rectal carcinoma who underwent potentially curative surgery between 1987 and 1992, 214 underwent PANP according to pre- and intraoperative staging. PANP was evaluated from the perspectives of oncologic outcome and urinary and male sexual function with a retrospective questionnaire in a group of patients followed prospectively. RESULTS: During the median follow-up of 53 months, local recurrence developed in 5.6% of patients; no local recurrence was observed in Dukes Stage A or Dukes Stage B patients. The 5-year survival rates of Dukes Stage A (n = 55), Dukes Stage B (n = 72), and Dukes Stage C (n = 87) patients were 96.4%, 84%, and 67.3%, respectively. Of patients undergoing preservation of the unilateral pelvic plexus alone, 93.5% maintained the ability to void spontaneously. Of patients who had complete preservation of the autonomic nerve system, 70.4% maintained male sexual function, and of patients who had removal of the hypogastric nerves and preservation of the pelvic nerve plexuses, 66.7%, were capable of erection and intercourse without normal ejaculation. CONCLUSIONS: Early stage rectal carcinoma should be treated both with local cure and complete preservation of urinary and sexual function. In high risk patients with suspected perirectal lymph node metastases and tumors invading the perirectal fat, the appropriate PANP should be applied with consideration of the balance between achieving a cure and preserving autonomic function.

Adult↗
PubMed2003

Autonomic denervation after the Maze procedure.

The Maze III procedure is a surgical operation for curative treatment of AF. The procedure is extensive, however, with multiple incisions in both atria, and its effects on autonomic regulation of the heart rhythm are not known. This study comprises 17 patients, 10 with paroxysmal AF and 7 with chronic AF, who had no concurrent cardiac disease known to affect heart rate variability (HRV). A 24-hour Holter recording was performed preoperatively and 2 months (early) and 7 months (late) after surgery, for analysis of HRV in the time and frequency domains. Early after the Maze procedure all HRV components were markedly reduced compared to baseline (mean +/- 1 SD): SDNN 73 +/- 13 versus 148 +/- 50 (ms), total power 168 +/- 126 versus 560 +/- 1567 (ms2), low frequency (LF) power 47 +/- 67 versus 826 +/- 677 (ms2), high frequency (HF) power 47 +/- 40 versus 678 +/- 666 (ms2), and LF:HF 1.22 +/- 0.9 versus 2.55 +/- 1.4. Late after the Maze procedure all variables were still reduced. Only total power increased significantly between early and late follow-up (168 +/- 126 vs 496 +/- 435 ms2). Late after Maze surgery, values of the different HRV components did not differ between the patients with paroxysmal AF and chronic AF. Early after the Maze procedure there is a marked decrease of all HRV components, which is maintained 7 months after surgery, a pattern consistent with denervation of the heart.

Atrial Fibrillation↗
PubMedDate not supplied

Pre- and postoperative electrogastrography in patients with gastric cancer.

BACKGROUND/AIMS: To investigate the changes of electrogastrography (EGG) after stomach resection, fasting and postprandial EGG were recorded in 10 volunteers and 23 gastric cancer patients who had undergone total or subtotal gastrectomy. METHODOLOGY: EGG signals in patients were recorded before and after surgery and were analyzed by power spectrum. RESULTS: The power spectrum components at three cycles/minute (cpm) as normal subject, had completely disappeared in all patients after total gastrectomy, and irregular powers, especially under 9 cpm, had increased. These results suggest that the activity of the 3-cpm component is specific for the stomach. In subtotal gastrectomy patients, 3-cpm power peaks were clearly observed in seven of twelve patients, but it was not recorded in the remaining five patients, who showed irregular powers similar to that in patients after total gastrectomy. Therefore, it was speculated that the area containing the "pacemaker" of gastric electric potentials was removed during gastrectomy in these five patients. The postprandial dip, which is considered to reflect autonomic nervous function, was not observed in six of seven subtotal gastrectomy patients who demonstrated the 3-cpm component in their EGG, and it was speculated that the gastric branch of the vagus nerve in these six patients might have been partially removed by surgery. CONCLUSIONS: These findings suggest that EGG is available as a non-invasive method to evaluate the motility and autonomic function of the remnant stomach after gastrectomy.

Adult↗
PubMed2001

Quality assurance in neurosurgery: United States concepts.

At present, quality assurance in United States neurosurgery is based primarily on neurosurgeons meeting requirements for certification by the American Board of Neurological Surgery and residency training programs meeting requirements for approval by the neurosurgical Residency Review Committee. These organizations, plus a number of other private, autonomous, physician directed groups have assumed responsibility for assuring neurosurgical quality. There are, however, no reliable data that such processes are effective and it is likely that neurosurgical quality assurance will move toward outcomes based documentation in the future. This article presents a brief review of the concepts of quality assurance and assessment as they are applied in the healthcare system of the United States. A more detailed review of the process of neurosurgical credentialing is also presented and a paradigm for evaluating and improving neurosurgical quality is proposed. It must be clearly stated that the opinions expressed in this article are those of the author and do not represent the official position of any neurosurgical organization.

Clinical Competence↗
PubMed2003

[The spastic hand. Postoperative rehabilitation].

Postoperative rehabilitation starts with preoperative evaluation of the patient. The outcome of rehabilitation measures is strongly dependent on the surgeon's ability to define a realistic rehabilitation aim, i.e., a goal the patient can achieve with a high degree of probability. Therefore, knowledge of the patient's individual basic situation and status as well as of the autonomic development of the different categories of cerebral palsy is of great importance. The operative procedures used are well established in cerebral palsy surgery. They are accepted as standard procedures. The decisive question is to whom they are offered. The same conditions pertain to the postoperative rehabilitation period. During that time a combination of functional bracing and physiotherapy plus occupational therapy is offered after primary cast immobilization. This period is finished when the specific aim has been achieved, i.e., integration of the gained function into everyday life.

Adult↗
PubMed2000

Disseminated thyroid autonomy or Graves' disease: reevaluation by a second generation TSH receptor antibody assay.

The clinical diagnosis of disseminated autonomy (DISA) can only be established by exclusion of Graves' disease (GD). Both hyperthyroid conditions share the same scintigraphic appearance and can only be distinguished from each other clinically either by the presence or absence of endocrine ophthalmopathy (EO) or thyrotropin (TSH) binding inhibiting immunoglobulins (TBIIs). The purpose of this study was the reevaluation of thyroid autonomies originally classified as DISAs by a second-generation radioreceptor antibody assay (RAA) (DYNOtest TRAKhuman) (B.R.A.H.M.S. Diagnostika, Berlin, Germany). The analysis included 32 patients (female: n = 25, male: n = 7; mean age: 46 +/- 18 years) who were initially diagnosed with DISA. All patients were TSH receptor (TSHR) antibody (TRAb) negative by a conventional radioimmunoassay (RIA) (TSH-REZAK RIA) (Medipan Diagnostica, Selchow, Germany) during their first evaluation. The presence of EO was excluded by clinical signs in all patients. Surgery had been performed prior to our evaluation in 5 patients and after our survey in 1 patient. Four patients had been treated previously with 131I. Ten patients were treated with thionamides during our evaluation, and 13 had not been treated before. One hundred three patients who had either healthy thyroids, nontoxic goiters, or focal autonomies served as controls and were evaluated both by the TSH-REZAK assay and the DYNOtest TRAKhuman assay. Seven of thirty-two (22%) patients originally classified as DISA were TRAb positive in the second-generation assay. In this group, 5 of 7 patients had a total thyroid volume (TTV) <30 mL (positive predictive value [PPW] for TRAb positivity 71%), and 5 of 7 patients had a diffuse goiter (PPW for TRAb-positivity 71%). Six of seven patients were anti-thyroperoxidase (TPO) positive (PPW for TRAb positivity 85%). A hypoechoid pattern on ultrasound was present by visual analysis in 3 of 7 patients (PPW for TRAb positivity 43%). A 100% PPW for TRAb positivity could be obtained if a goiter <30 ml was combined with anti-TPO positivity, but this combination was present in only 4 of 7 (57%) patients. With the second-generation assay, one false positive test result was observed in the control group. Surgery was performed in 6 patients who were TRAb negative in both assays. In all these cases, the histologic findings were compatible with autonomous transformation of the thyroid. Our study demonstrates that a significant number (22%) of patients formerly classified as DISA may actually have GD. However, DISA still exists as a clinical entity, and its pathophysiological link to multifocal and unifocal autonomy should be further investigated.

Adult↗
PubMed1982

[Obstructive hypertrophic myocardiopathy and Osler's endocarditis].

Four cases of bacterial endocarditis (BE) complicating hypertrophic obstructive cardiomyopathy (HOCM) were observed between 1978 and 1980. The causal organism was a streptococcus in all cases and the portal of entry, dental. The mitral regurgitation (MR) observed in HOCM as an epiphenomenon of the obstruction became autonomous in 2 patients as shown by phonocardiography with methoxamine. In one case, the MR became severe and justified mitral valve replacement; at surgery, the chordal rupture suspected on echocardiography was confirmed. Antibiotic therapy was effective on the infectious process in all cases. However, 2 of the 4 patients died, one of thrombosis of the mitral prosthesis on the 15th postoperative day, and the other of a cerebrovascular accident. None of the patients had a detectable aortic or septal infectious lesion. Eight of 27 reported cases (30 p 100) of HOCM complicated by BE were operated; 10 (37 p. 100) died as a result of the endocarditis. These cases underline the incidence of BE in HOCM (5 p. 100) its gravity and the necessity for systematic antibiotic prophylaxis, especially before dental treatment.

Adult↗
PubMed1992

Heart rate control in awake dog after selective SA-nodal parasympathectomy.

Selective surgical sinoatrial (SA)-nodal parasympathectomy (PSX) was used to distinguish the role of the cardiac autonomic nerves in heart rate (HR) control in awake dogs (n = 8) during rest and behavioral arousal. Resting HR increased from 85 +/- 9 beats (mean +/- SE) before surgery to 114 +/- 6 beats after denervation (P less than 0.05). Atrioventricular (AV)-nodal block occurred during the first 1-3 wk post-PSX, but subsequently resolved. Dogs were behaviorally conditioned by following a 30-s tone (CS+) by a 0.5-s shock. Before denervation the CS+ evoked an initial, rapidly developing tachycardia (phase 1), which was followed by a more slowly developing, but larger, phase 2 tachycardia. The selective SA-nodal parasympathectomy essentially abolished the phase 1 conditional HR response (magnitude: 23 +/- 5 vs. 5 +/- 2 beats, pre- vs. postdenervation, respectively). The phase 2 HR increase was similar before and after the denervation (magnitude: 44 +/- 6 vs. 33 +/- 6 beats; rate of increase: 5 +/- 1 vs. 6 +/- 1 beats/s, pre- vs. post-PSX). Beta-Blockade (propranolol, 1 mg/kg) after PSX decreased phase 2 (magnitude: 7 +/- 3 beats; rate of increase: 1 +/- 0.3 beats/s). These data reveal a sterotypic pattern of change in cardiac autonomic nervous drive during a sudden arousal from rest. Phases 1 and 2 appear to be selective and specific indexes of changes in SA-nodal parasympathetic and sympathetic tone, respectively. The selective denervation unmasks during stress a component of HR control that occurs in the absence of adrenergic or cholinergic mechanisms. These data suggest that multiple interactions occur within the intrinsic ganglion plexuses of the heart with respect to HR control.

Animals↗
PubMed1998

Right vagal nerve stimulation during minimally invasive direct coronary artery bypass grafting in dogs. A preliminary study.

BACKGROUND: Minimal access coronary artery bypass grafting without cardiopulmonary bypass has been used with increasing frequency. However, some surgeons are still unwilling to perform MIDCAB because the anastomosis is technically demanding. The aim of this study was to assess whether autonomic activation via right vagal nerve stimulation will be an effective support technique on heart rate during MIDCAB in dogs. EXPERIMENTAL DESIGN: Preliminary study. SETTING: Cardiothoracic Surgery Unit, University Clinic. METHODS: The right cervical vagal nerve was stimulated in five dogs. In one dog, right thoracotomy was performed to isolate the vagal nerve. Bipolar hook electrodes were attached to the vagal nerve. The vagal nerve was stimulated (3-5 mA, 40 Hz) for a few seconds while suturing the coronary artery. Experiments were conducted in two groups. In Group I, two dogs received vagal stimulation via the right neck, and one dog received vagal stimulation via the right thoracic cavity approach. In Group H, all vagal stimulations were performed via the neck during intravenous infusion of diltiazem (10 mg/hrs) or verapamil (5 mg/hrs). RESULTS: In Group I, when the cervical nerve stimulation started the heart rate decreased from 190 to 45 beats/min in one dog, and from 180 to 42 beats/min in another dog. During thoracic nerve stimulation, the heart rate decreased from 205 to 70 beats/min. In Group II, vagal stimulation of one dog (10 mg/hr diltiazem) caused ventricular arrest, and in the other dogs (5 mg/hr verapamil) vagal stimulation caused marked bradycardia with atrioventricular block. After the cessation of nerve stimulation, the heart rate returned to normal sinus rhythm immediately in each dog. CONCLUSIONS: Based on our findings, this type of autonomic stimulation (especially with i.v. administration of diltiazem or verapamil) can be an effective technique in reducing heart beats, thus obtaining relatively quiet surgical field for coronary anastomosis in CABG without cardiopulmonary bypass.

Animals↗
PubMed1996

Lumbosacral plexopathy after gynecologic surgery: case report and review of the literature.

Very unusual lumbosacral plexopathy, symptoms appearing after an uncomplicated abdominal hysterectomy prompted a review of the literature. The patient's symptoms spanned the somatic and autonomic systems and ranged from T-11 to S-4; a cause that would explain these is perplexing. Pelvic neuroanatomy and plexopathy symptoms are presented. Etiologies of neurologic symptoms are discussed and preventive strategies are explored.

Adult↗
PubMed1994

Advances in rectal cancer surgery.

PURPOSE: We discuss our experience in radical rectal cancer surgery and critically review the results of the current literature. In particular, the importance of distal clearance, total excision of the mesorectum, and pelvic lymphadenectomy is stressed. METHODS AND RESULTS: The rationale for determining a pelvic lymphadenectomy is identified in the high percentage (20 percent) of lateral endopelvic metastatic nodes demonstrated in cases of extraperitoneal rectal cancers. The results after pelvic lymphadenectomy and the eventual complications are observed. The autonomic nerve-sparing procedure is described and the preliminary results, with a decreased rate of urinary and sexual sequelae, are discussed. CONCLUSIONS: It was concluded that, in cases of an advanced rectal cancer, radical surgery, if associated with the nerve-sparing technique, can improve survival without affecting the incidence of major complications.

Humans↗
PubMed1982

Dopaminergic mechanisms regulating prolactin secretion in patients with prolactin-secreting pituitary adenoma. Long-term studies after selective transsphenoidal surgery.

Twenty-seven female patients with prolactin-secreting pituitary microadenoma, were studied at different intervals following selective transsphenoidal removal of the tumor. Postoperatively, all patients had normal prolactin (PRL) levels and regular menstrual cycles were restored. Sixteen of 27 patients showed positive responses to TRH and metoclopramide (MCP) within 1 mo after surgery. On the contrary, 9 patients showed evaluation of these patients demonstrated that normal neuroendocrine relationships were restored after several months since positive PRL responses to TRH and MCP could be elicited in such patients. The remaining 2 patients who showed basal PRL levels in the upper range of normal, exhibited negative responses to TRH and MCP. These patients had progressively to TRH and MCP exhibited 10-20 mo after surgery a normal decrease in PRL levels following administration of carbidopa plus L-Dopa. Negative responses to carbidopa plus L-Dopa were instead obtained in 6 postoperative patients with elevated PRL levels and negative responses to TRH and MCP. These results suggest that: 1) Hyperprolactinemia induced by "autonomous" pituitary adenomas increases hypothaLamic dopamine (DA) secretion, which in turn inhibits PRL secretion by nonadenomatous lactotropes. 2) Total selective removal of the microadenoma acutely decreases PRL concentration, but a functional inhibition of the normal lactotrope can persist for a period of few months following surgery in a certain number of patients. 3) Prolonged reduction of PRL concentration is accompanied to a normal DA tone with reestablishment of normal neuroendocrine relationships.

Adenoma↗