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At least 829 records · Page 46Linked to original sources
PubMed1999

Comparative localization of heme oxygenase-2 and nitric oxide synthase in the autonomic innervation to the human ductus deferens and seminal vesicle.

PURPOSE: The aim of present study was to determine the topographic relationship between heme oxygenase-2 (HO-2), which synthesizes carbon monoxide (CO), and neuronal nitric oxide synthase (nNOS), which generates nitric oxide (NO), in the autonomic nerves of the human ductus deferens and seminal vesicle. MATERIALS AND METHODS: Specimens of the ductus deferens and seminal vesicle were obtained during cancer surgery or vasectomy. HO-2 and nNOS were localized by indirect immunofluorescence. Additionally, the histochemical NADPH-diaphorase (NADPH-d) activity of NOS was demonstrated using a standard staining method and some modifications. RESULTS: Anti-HO-2 labeling stained virtually all nerve cell bodies in local ganglia of the pelvic plexus, which is composed of a mixed population of postganglionic sympathetic and parasympathetic neurons supplying the pelvic viscera. Furthermore, nerve cell bodies in the wall of the seminal vesicle, which are considered an extension of the pelvic plexus, were also found to stain positively for HO-2. Some of the HO-2-immunoreactive ganglion cells were also nNOS-positive, their proportion varying between individual ganglia but generally not exceeding 20%. Both enzymes were present in large adventitial nerve trunks. Only nNOS but no HO-2 was found in small intramuscular and mucosal nerve fibers. In both the ductus deferens and seminal vesicle, the highest density of nNOS-containing nerve fibers was in the lamina propria of the mucosa. A well-developed plexus of nNOS-positive nerve fibers was also observed in the muscular layer of the seminal vesicle. By contrast, there was a very sparse innervation by nNOS-positive nerve fibers in the muscle coat of the ductus deferens. In addition, a population of epithelial cells in the seminal vesicle may contain an isoform of NOS, as revealed by a resistant NADPH-d activity. CONCLUSIONS: These findings set the scene for functional studies which will hopefully clarify the biological role of CO and NO in the control of the ductus deferens and seminal vesicle.

Aged↗
PubMed2003

Advances in surgical treatment of rectal cancer.

UNLABELLED: Increased understanding of the natural history of the disease, standardization of surgery and new procedures have led to significant advances in the treatment of rectal cancer. Anatomical dissection of the mesorectum permits optimal local control and volume cases may further improve oncological RESULTS: Autonomic pelvic nerves are preserved by the technique of total mesorectal excision (TME) and adapted anterior dissection plans improve preservation of genito-urinary functions. Sphincter preservation can be achieved by a conventional anterior resection for high and mid-rectal tumours, and by the technique of intersphincteric resection for low tumours. A J-pouch or a recently-designed coloplasty pouch must be associated with coloanal anastomoses in order to improve functional results and loop ileostomy is recommended to decrease early postoperative morbidity. Local excision constitutes an alternative to major surgery in patients with a low-risk early rectal cancer. Neoadjuvant treatments have a role in local control of the disease after TME surgery and in new strategies of sphincter-saving procedures. The place of anorectal reconstruction and that of laparoscopy are also discussed.

Adenocarcinoma↗
PubMedDate not supplied

Endoscopic thoracic sympathetic block by clipping for recurrent palmar hyperhidrosis.

Postoperative complications of endoscopic thoracic sympathectomy may be troublesome in some patients. Between January 1998 and September 2002, a total of 16 patients with recurrent palmar hyperhidrosis underwent video-assisted thoracoscopic T2 and T3 sympathetic block. There were seven men and nine women, with a mean age of 21.1 years (range, 12-35 years). All patients were placed in a semi-sitting position under single-lumen intubated anesthesia. We performed the T2 sympathetic block for patients with still intact T2 ganglion using an 8-mm, 0 degrees thoracoscope. An additional T3 block should be given if patients received either previous T2 sympathectomy or elevated palmar temperature <1 degrees C after T2 sympathetic block. The mean operation time was 30 minutes. The level of sympathetic blocks were the T2 and T3 in five patients, only T2 block in four, patients, and only T3 block in seven patients. Improvement of palmar hyperhidrosis can be obtained in all patients. One patient received a reverse operation 12 days after the T2 and T3 clipping and obtained improvement of troublesome compensatory sweating and dry hands 1 day after removal of all clips. All patients obtained improvement of palmar hyperhidrosis without recurrence after a mean of 37.1 months of follow-up (range, 12-56 months). Endoscopic thoracic T2 with or without T3 sympathetic block by clipping is a safe and effective method in treating patients with recurrent palmar hyperhidrosis.

Adolescent↗
PubMed2001

[Acute experimental pancreatitis in the opossum. The role of prior truncular vagotomy on the inflammatory response].

BACKGROUND: Acute pancreatitis (AP) is a common cause of admission to the emergency room. Its etiopathogeny is poorly understood. The pancreatic inflammatory response in this process is unclear. The influence of the autonomic nervous system is a controversial issue. AIMS: To demonstrate the effects of truncular vagotomy on AP due to duodenal distention in the South American opossum. PLACE OF APPLICATION: Department of experimental surgery (Churruca-Visca Hospital) INEUCI (Neuroscience Institute, CONICET, UBA). POPULATION: Male and female South American opossum divided into: a control group (7 animals); group A: truncular vagotomy and pyloroplasty seven days after the onset of AP (7 animals). Group B: truncular vagotomy and pyloroplasty 30 days after provoking AP (7 animals). Group C: truncular vagotomy and pyloroplasty 45 days after the onset of AP (7 animals). METHODS: Acute pancreatitis was caused by duodenal distention of the second portion by inserting a Foley catheter through a gastrostomy. CONCLUSIONS: The method of provoking AP is original. The influence of autonomous nervous system is being underestimated in most of the literature available.

Acute Disease↗
PubMed1996

Alterations in spectral characteristics of heart rate variability as a correlate of cardiac autonomic dysfunction after esophagectomy or pulmonary resection.

BACKGROUND: Both esophagectomy and pulmonary resection are associated with postoperative cardiac complications, partly because of autonomic perturbations involving the heart. This study was undertaken to determine whether heart rate variability (HRV), employed as an index of cardiac autonomic function, changes in patients undergoing esophagectomy or pulmonary resection. METHODS: Electrocardiographic RR intervals were measured in 20 esophagectomized patients, 10 undergoing right and 10 undergoing left pulmonary resection on the preoperative day as baseline data and on postoperative days 1, 3, 5, 7, 14, and 30. Instantaneous heart rate was calculated every 250 ms from 416-s data of RR intervals. Power spectra of HRV for 128 s were computed using a fast Fourier transform and normalized by squared mean heart rate. The average ten sets of normalized HRV power were obtained by integrating the following power spectral bands: the low-, (0.06-0.10 Hz), high- (0.15-0.40 Hz), and total-frequency regions (0.01-0.40 Hz). RESULTS: In the esophagectomy group, mean low-, high-, and total-frequency HRV power decreased after surgery to 17%, 6%, and 15% of their preoperative values, respectively, and these indexes remained suppressed for up to 30 days. After right pulmonary resection, low- and total-frequency HRV power decreased through 30 and 7 postoperative days, respectively. In the left pulmonary resection group, HRV remained unchanged. In the esophagectomy group, mean (+/- SEM) heart rate increased from 78 (+/- 3) bpm to more than 90 bpm throughout the study, and body temperature from 36.5 (+/- 0.1) degrees C to more than 37.0 degrees C through 14 postoperative days. Heart rate and body temperature remained increased for 3 days after pulmonary surgery. Mean arterial pressure remained unchanged in the three surgical groups. CONCLUSIONS: Reductions indicate HRV after esophagectomy or right pulmonary resection indicate a substantial and prolonged surgical injury to the autonomic nervous control of pulse rate.

Aged↗
PubMed1991

Reflex sympathetic dystrophy syndrome: consensus report of an ad hoc committee of the American Association for Hand Surgery on the definition of reflex sympathetic dystrophy syndrome.

This report proposes that reflex sympathetic dystrophy be defined as a pain syndrome in which the pain is accompanied by loss of function and evidence of autonomic dysfunction. In the clinical setting, this diagnosis is usually associated with other anatomic and psychological diagnoses and may be associated with a variety of systemic illnesses and medicolegal factors. All components should be assessed before a treatment plan is established. Priorities should go to emergency care, acute injuries, and systemic illness, psychiatric problems, and chronic anatomic problems, in that order. Early, accurate diagnosis improves prognosis.

Consensus Statements as Topic↗
PubMed2005

Contrast nephropathy may be partly mediated by autonomic dysfunction: renal failure considered as a modern maladaptation of the prehistoric trauma response.

The mechanism behind iodinated radiocontrast nephropathy remains elusive. Direct oxidative damage is the prevailing hypothesis, but the apparent protective effect of iodine against oxidation contradicts this view. We propose that autonomic dysfunction participates in the pathogenesis of radiocontrast nephropathy and may account for other contrast-associated reactions previously attributed to allergy. Iodine, through its effects on thyroid function and chemoreceptor response to metabolic acidosis, may induce hyperadrenergia and consequently diminish renovascular flow and urine output. The renal response to adrenergia likely served an adaptive function during prehistoric evolution when trauma was a dominant source of hypovolemia and adrenergia, but the response may behave maladaptively today as evolutionarily nai ve triggers for adrenergia have emerged. Autonomic dysfunction can further impair renal function by deranging renovascular autoregulation and inducing oxidative reperfusion injury as a secondary phenomenon. Many other causes of acute renal failure such as drug toxicity, surgery, hospitalization, and diabetes may operate through hyperadrenergia, impaired renovascular autoregulation, and oxidative reperfusion injury. Dialysis, a volume reduction therapy for renal failure, can counterintuitively worsen renal dysfunction by exacerbating adrenergia, which may explain its association with accelerated atherosclerosis, inflammation, and cancer. Other examples of vicious cycles that perpetuate renal dysfunction may include renal artery stenosis, carotid stenosis, and atherosclerosis as well as the cardio-renal, hepato-renal, and pulmonary-renal syndromes. The benefits of hydration and bicarbonate in protecting renal function may operate in part through baroreceptor- and chemoreceptor-mediated reduction of sympathovagal ratio, respectively. New treatment paradigms for renal failure including pharmacologic and electro-mechanical therapies are envisioned based on autonomic remodeling, reduced sympathovagal ratio, and neuromodulation of pathways typically associated with trauma such as renin, angiotensin, vasopressin, and aldosterone.

Adaptation, Physiological↗
PubMed1993

Propofol-fentanyl anaesthesia in cardiac surgery: a comparison in patients with good and impaired ventricular function.

The haemodynamic effects of propofol-fentanyl anaesthesia for elective cardiac surgery were compared in 24 patients with good left ventricular function (ejection fraction > 45%, left ventricular end-diastolic pressure < 16 mmHg) and nine patients with impaired function. Anaesthesia was induced with fentanyl 25 micrograms.kg-1 and pancuronium 0.1 mg.kg-1 and was maintained with a variable rate propofol infusion, mean rate 2.61 mg.kg-1 x h-1 in the good ventricular function group and 2.71 mg.kg-1 x h-1 in the impaired function group. Additional fentanyl 7.5 micrograms.kg-1 was given before sternotomy. Ventilation to normocarbia was with air and oxygen (FIO2 0.6). Haemodynamic measurements were made before induction, after tracheal intubation, before and after sternotomy and before aortic cannulation. There were no significant differences between the groups in any haemodynamic variables during the study. Twenty minutes after intubation both groups showed a decrease from pre-induction values in mean arterial pressure (p < 0.05) and left ventricular stroke work index (p < 0.05), the reduction in left ventricular stroke work index remaining significant during the prebypass period in both groups. There were no significant changes in right or left sided filling pressures, systemic vascular resistance or heart rate. The technique decreased cardiac work and effectively controlled the autonomic responses to sternotomy in both groups. This study suggests that propofol may be a suitable adjunct to opioid anaesthesia in patients with impaired ventricular function having cardiac surgery.

Adolescent↗
PubMed1996

Atrial arrhythmia following a biatrial approach to mitral valve surgery.

The biatrial approach to exposing the mitral valve during surgery has the potential for improving visualization of the valve with minimal cardiac manipulation. This procedure, involving a right atriotomy and an extended transseptal incision, may isolate the sinus node from its normal blood supply and autonomic innervation. Thirty-eight consecutive patients undergoing this procedure were examined. Twenty-two of these patients (58%) were admitted in normal sinus rhythm and 15 (40%) were in atrial fibrillation (AF) or atrial flutter. Of the 22 patients admitted in normal sinus rhythm, only 3 patients remained in this rhythm at discharge. Fourteen of the 22 patients were discharged in a slow, low atrial rhythm. All of the patients admitted in AF were discharged in AF. Of the 14 patients discharged in a low atrial rhythm, the rhythm persisted in eleven patients (80%) at a mean of 6-month follow-up. The routine use of this transseptal approach to mitral valve surgery needs further assessment in light of the predictable loss of the sinus mechanism.

Adult↗
PubMed1997

Time-dependent changes in heart rate and pupil size during desflurane or sevoflurane anesthesia.

UNLABELLED: To better characterize alterations in autonomic function associated with prolonged anesthesia, we tested the hypothesis that the time-dependent effects of sevoflurane and desflurane differ. We studied seven male volunteers, each anesthetized for 8 h with 1.25 minimum alveolar anesthetic concentration desflurane on one study day and with 8 h sevoflurane on another. These volunteers did not undergo surgery and were minimally stimulated during the study. Measurements included blood pressure, heart rate, pupillary size and light reactivity, concentrations of serum catecholamines, and carbon dioxide production. Over time, heart rate and pupil size increased significantly. During 6 of the 14 anesthetics (45%), heart rate at some point exceeded 95 bpm; similarly, pupil size at some time exceeded 5 mm during 8 anesthetics (57%). In contrast, plasma catecholamine concentrations and carbon dioxide production remained unchanged, and blood pressure remained nearly constant. There are thus substantial time-dependent changes in autonomic functions during prolonged anesthesia, even in unstimulated, nonsurgical volunteers, but we could not detect a difference in these changes during desflurane compared with sevoflurane anesthesia. IMPLICATIONS: Pupil size and heart rate changes are used to guide the delivery of anesthesia. In volunteers, pupil size and heart rate increased with increasing duration of constant desflurane or sevoflurane anesthesia. Thus, anesthetic duration alters heart rate and pupil size independent of surgery and changes in anesthetic delivery.

Anesthesia, Inhalation↗
PubMed2006

Endoluminal minirobots for transgastric peritoneoscopy.

The performance of surgeries through small incisions or natural orifices minimizes the invasiveness to the patient as compared to open procedures. However, the constraints on visual feedback and dexterity limit the scope of these procedures. Recent robotic technologies attempt to mitigate these constraints for flexible endoscopy and laparoscopy. Much of the current work in flexible endoscopy is in the development of a fully autonomous endoscope capable of providing the surgeon with better control. Advancements in laparoscopic technologies have demonstrated abilities to improve visualization and dexterity through telerobotics and in vivo robotics. The application of new robotic technologies in flexible endoscopy and laparoscopy to natural orifice surgery promises to further benefit the patient by eliminating abdominal incisions, scarring, and the pain associated with these incisions. The safety and feasibility of such robotic technology has been successfully demonstrated for natural orifice transluminal endoscopic surgery (NOTES) in animal models.

Animals↗
PubMed2002

[Erectile dysfunction. An important manifestation of autonomic diabetic neuropathy].

In Germany, some 4-6 million men, including 1.2 million diabetics, suffer from erectile dysfunction (ED). Various other diseases including heart disease, hypertension, arteriosclerosis, hyperlipidemia, endocrine disorders, chronic renal insufficiency, prior radical prostatectomy, neurological diseases, trauma and the abuse of alcohol, tobacco, and side effects of medications, are frequently associated with ED. Medical history, clinical examination, routine blood chemistry and sexual hormone levels may help clarify the etiology of ED. Normally, relaxation of the smooth muscles of the corpus cavernosum--mediated by cGMP and cAMP--together with dilatation of penile arteries and occlusion of venous outflow, results in an erection. The oral type V phosphodiesterase inhibitor, Sildenafil, or prostaglandin E1 injection elevates the cGMP and cAMP levels, respectively. Other therapeutic options include mechanical aids, surgery, hormone replacement or sublingual apomorphine. Since 1998, Sildenafil, an effective, simple and safe oral treatment, has been available.

Aged↗
PubMed2005

Cerebral hemorrhage due to autonomic dysreflexia in a spinal cord injury patient.

STUDY DESIGN: Case report. OBJECTIVE: To report an uncommon case of cerebral hemorrhage due to autonomic dysreflexia (AD) in a spinal cord injury (SCI) patient. SETTING: Institut Guttmann, Neurorehabilitation Hospital in Barcelona, Spain. CASE REPORT: An SCI patient developed AD due to urinary tract infection after surgery for a pressure sore. The hypertension was difficult to control and the case progressed to hypertensive encephalopathy. MRI of the brain was performed showing a hemorrhagic lesion on the left occipital area. The hypertension was finally controlled and the neurological status improved although with some cognitive deficits. CONCLUSION: This is an uncommon case of cerebral hemorrhage due to AD, showing the importance of an adequate diagnosis and treatment of AD to avoid this life-threatening complication.

Autonomic Dysreflexia↗
PubMed1998

Thyroid nodules: malignant or benign?

Palpation of a thyroid nodule should initiate a workup to exclude the rare but dangerous possibility of malignancy or autonomous function. Clinical evaluation will at times provide clues to malignancy, but the diagnostic cornerstone is fine-needle aspiration biopsy. Treatment may include observation, surgery, levothyroxine, or radioactive iodine.

Adult↗
PubMed1997

Avoiding complications of radical retropubic prostatectomy.

During the past 15 years radical retropubic prostatectomy (RRP) has become the treatment of choice for localized prostate cancer. Before the 1980s the procedure was characterized by a significant number of intraoperative, postoperative and long-term complications. Since then the operation has evolved continuously, using the results from anatomical studies, and has resulted in a marked reduction in the morbidity and mortality associated with this procedure. The modern, anatomical approach to RRP emphasizes the principles of direct visualization and identification of the anatomical structures in the pelvis. Management of the dorsal vein complex and techniques for apical resection of the prostate, combined with improved understanding of the pelvic floor anatomy, have contributed to a reduced frequency of postoperative incontinence. The identification and localization of the "erectile nerves' (autonomic branches of the pelvic plexus to the corpora cavernosa) in the neurovascular bundles outside the prostatic capsule and Denonvilliers' fascia enables nerve-sparing surgery. In selected cases, sparing of the neurovascular bundles is possible to preserve sexual function without compromising cancer control as the principal goal of RRP.

Blood Loss, Surgical↗
PubMed1990

Unilateral cerebral inactivation produces differential left/right heart rate responses.

We studied heart rate following unilateral hemispheric inactivation by intracarotid amobarbital in 25 patients undergoing preoperative evaluation for epilepsy surgery. Heart rate increased after left hemisphere inactivation, but decreased following right hemisphere inactivation. The results are consistent with differential left/right cerebral hemispheric effects on autonomic function, and appear related to functional and anatomic asymmetries in both the central and peripheral nervous systems.

Adolescent↗