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PubMed1983

Computed tomographic evaluation of the thoracic prevertebral and paravertebral spaces.

The thoracic prevertebral and paravertebral spaces are defined by the vertebrae and fascial planes. Many important structures lie within these spaces, for example, the intercostal arteries, descending aorta, the azygos and hemiazygos veins, sympathetic nerve trunk, thoracic duct, and lymph nodes. Computed tomography has been notably successful in evaluating the mediastinum and specifically the prevertebral and paravertebral spaces. Computed tomography of the normal anatomy and some examples of pathology involving these specific areas are presented. Computed tomography is strongly indicated to evaluate pathology in this area.

Humans↗
PubMed1991

Cervical and thoracic pain.

The cervical spine has long been an area in which the assumption is made that no undescribed anatomy and physiology will be forthcoming. Herein described are cervical anatomy and physiology that have not been reported, as well as anatomy that has been extensively described but does not exist. Fresh research needs to be done on the distinctive and poorly understood characteristics of the autonomic nervous system in the cervical spine. Included in research reports are evidence of herniation of intradiscal gas; efficacy of early mobilization of patients with long-standing neck pain; successful surgical treatment relieving severe hemicranial migraine attack; and the use of magnetic resonance imaging in thoracic disk herniation, permitting precise localization and determination of the magnitude of cord compression.

Cervical Vertebrae↗
PubMed1987

Neurophysiologic maps of cutaneous innervation of the external genitalia of the ram.

The area of skin innervated by the afferent fibers in a peripheral nerve is called the cutaneous area (CA) of that nerve. Mapping of those areas that were responsive to movement of wool/hairs in the genital region of 18 anesthetized rams, combined with subsequent identification of spinal nerves and dissection of the pudendal nerve plexus, indicated considerable differences in the extent of the CA and the origins of cutaneous branches from the pudendal plexus. The CA of the proximal and distal cutaneous branches of the pudendal nerve (or plexus) overlapped craniocaudally by approximately one-half, and the latter included most of the skin of the ipsilateral half of the scrotum. The CA of the deep perineal and caudal rectal nerves lay immediately adjacent to the anus. The CA of the scrotal branches of the pudendal nerve were restricted primarily to the scrotum. Fascicles in the dorsal nerve of the penis irregularly supplied CA along the length of the prepuce and consistently supplied the cranial free end of the prepuce. The CA of the ventral cutaneous branches of the caudal thoracic spinal nerves, the first 2 or 3 lumbar spinal nerves, and the genitofemoral nerve extended to the midline of the prepuce. Overlapping of CA was extensive, especially on the prepuce.

Animals↗
PubMed1990

Efficacy of continuous extrapleural intercostal nerve block on post-thoracotomy pain and pulmonary mechanics.

To assess the efficacy of continuous extrapleural intercostal nerve block on postoperative pain and pulmonary function, a prospective, randomized, double-blind, placebo-controlled trial was conducted on 56 patients undergoing elective thoracotomy. Infusion was started before closing the chest and was continued for 5 days. Subjective pain relief was assessed on a linear visual analogue scale. Pulmonary function was measured on the day before operation and daily for 5 days. There were 29 patients in a group which received bupivacaine and 27 in a control group which received saline. The bupivacaine group had lower pain scores (P less than 0.01) and required less papaveretum (P less than 0.01) than the control group. Forced vital capacity, forced expiratory volume in 1 s and peak expiratory flow rate were maximally reduced at 24 h to median values of 56, 60 and 57 per cent, respectively, of preoperative control values in the bupivacaine group, and to 25, 30 and 32 per cent in the control group. These differences are highly significant (P less than 0.01). Restoration of pulmonary function was superior in the bupivacaine group (P less than 0.01). There were no infusion-related complications. After thoracotomy, continuous intercostal blockade with bupivacaine is a safe and effective method of pain relief which reduces the early loss of postoperative pulmonary function significantly and more rapidly restores respiratory mechanics.

Adult↗
PubMed2004

Engineering novel spinal circuits to promote recovery after spinal injury.

We have developed an innovative way to establish a functional bridge around a spinal lesion. We disconnected the T13 nerve from its muscle targets, leaving the proximal end intact. The cut end was inserted either into an intact spinal cord, to assess regeneration of T13 axons into the cord and synapse formation with spinal neurons, or caudal to a hemisection at L2/3, to assess restoration of function below the injury. Four to 28 weeks later, anterograde tracers indicated that axons from the inserted T13 nerve regenerated into the ventral horn, the intermediate zone, and dorsal horn base, both in intact and hemisected animals. Antibodies to cholinergic markers showed that many regenerating axons were from T13 motoneurons. Electrical stimulation of the T13 nerve proximal to the insertion site 4 weeks or more after insertion into the intact cord evoked local field potentials in the intermediate zone and ventral horn, which is where T13 axons terminated. Stimulation of T13 in 71% of the animals (8 hemisected, 7 intact) evoked contraction of the back or leg muscles, depending on the level of insertion. Animals in which T13 was inserted caudal to hemisection had significantly less spasticity and muscle wasting and greater mobility at the hip, knee, ankle, and digits in the ipsilateral hindlimb than did animals with a hemisection only. Thus, T13 motor axons form novel synapses with lumbosacral motor circuits. Because the T13 motor neurons retain their connections to the brain, these novel circuits might restore voluntary control to muscles paralyzed below a spinal lesion.

Animals↗
PubMedDate not supplied

Clinical illness in a wild turkey with Laminosioptes cysticola infestation of the viscera and peripheral nerves.

Laminosioptes cysticola, the fowl cyst mite, was found in peripheral nerves and thoracic and abdominal viscera of an emaciated eastern wild turkey (Meleagris gallopavo) exhibiting severe torticollis, circling, loss of balance, and wing droop. Mites, sometimes accompanied by granulomatous inflammation, were abundant in brachial plexus and sciatic nerves. Mild lymphoplasmacytic perivascular cuffing was present in the cerebellum, but no direct evidence of mites or other infectious agents was found in the central nervous system. This is the first report of L. cysticola infestation in a wild turkey and of the invasion of nervous tissue by this mite.

Animals↗
PubMed2006

[Recent progress in diagnosis and treatment of the injury to the peripheral nerve].

OBJECTIVE: To investigate the latest development in diagnosis and treatment of the injury to the peripheral nerve. METHODS: The literature at home and abroad was reviewed, and the research findings with clinical experience in diagnosis and treatment for the injury to the peripheral nerve were summarized. RESULTS: The treatment for the total brachial plexus avulsion injury was successfully performed by the extra-plexus nerve transfer. The avulsion of the brachial plexus could be directly repaired by the healthy C7 nerve root transfer through the anterior spinal approach. The forearm flexors could be reinforced by the neurovascularized gracilis transplantation. MRI and CTM were the best methods of early diagnosis for the brachial plexus injury. The pure upper or lower root avulsion of the brachial plexus injuries could be repaired by the intra-plexus nerve transfer, which involved a transfer of part of the ulnar nerve in the arm to the motor nerve of the biceps for C5-C6 avulsion of the brachial plexus,and a transfer of selective fascicles of the healthy C7 nerve root or brachial muscle branch to the flexors muscle fascicles of the median nerve or anterior interosseous nerve. The thoracic outlet syndrome always occurred in this position when the neck muscle fatigue occurred in the typists or the game-players after their longstanding looking forwards. The C5 and C6 roots were rolled by the tendenofibrotic tissue at the origin of the scalenus. After a procaine block, the symptom subsided. Radiation neuropathy was a series of pathological changes caused by overdoses of the radiation therapy. The pathologic findings consisted of a series of vessel damages and final coagulation necrosis, which induced clusters of abnormally-dilated, thin-walled telangiectasias. Radiation neuropathy could be detected by MRI and could be differentiated from tumor. Once the diagnosis was established, the therapy should be begun early, including the systemic use of steroids, anticoagulation, and hyperbaric oxygen. CONCLUSION: Great progress has been made in diagnosis and treatment of the injury to the peripheral nerve, but a further study should be performed to promote regeneration of the nerves and reconstruction of the related functions.

Brachial Plexus↗
PubMed1984

Innervation of the canine thoracolumbar vertebral column.

The pattern of innervation of the caudal thoracic and cranial lumbar vertebral column of the dog is described. Frozen sections stained with Schofield's silver impregnation method show that the dorsal longitudinal ligament is profusely innervated, while the anulus fibrosus contains a few nerves limited to its outermost layers; no nerves are present in the nucleus pulposus. Following injection of horseradish peroxidase (HRP) into the anulus fibrosus of the thoracolumbar intervertebral disc and subsequent removal and staining of dorsal root ganglia, the reaction product is found in ganglia as far as two segments cranially as well as caudally, demonstrating that the disc is innervated by nerves arising from several spinal cord segments. A meningeal ramus, which innervates the discs of man, could not be found by gross dissection. Dissections show each vertebral articular facet innervated by the medial branches of two contiguous spinal nerves, a pattern further confirmed by injections of HRP into facet joints with subsequent staining of dorsal root ganglia. The dorsal rami of spinal nerves often divide into medial, intermediate, and lateral branches rather than the traditionally described division into only medial and lateral branches.

Animals↗
PubMed1981

Tonic catecholaminergic inhibition of the spinal somato-sympathetic reflexes originating in the ventrolateral medulla oblongata.

In chloralose-anesthetized cats activity of the spinal and supraspinal components of the somato-sympathetic reflex were evoked in the white ramus at T3 by stimulation of the corresponding intercostal nerve. A blockade of all spinal pathways by means of a reversible cold blockade of the spinal cord at C2-C3 produced the following effects: (1) mean arterial blood pressure fell to 30-50 mm Hg and the tonic background activity in the white ramus was markedly reduced; (2) the amplitude of the spinal reflex was significantly increased and the supraspinal reflex was completely abolished; (3) localized cold block of the dorsolateral funiculus produced the same effect as cold block of the whole spinal cord; (4) neither baroreceptor denervation nor midcollicular decerebration altered these effects; and (5) the alpha-adrenoceptor agonist clonidine reduced the increased amplitude of the spinal reflex during cold blockade; this effect was reversed by the alpha-adrenoceptor antagonist yohimbine. Bilateral cold blockade of areas on the ventrolateral surface of the brain stem between the rootlets of the hypoglossal nerve and the trapezoid body caused the same effect on background and reflex activity in the white ramus as did spinal cord blockade. A mapping of the catecholaminergic (CA) neurons in the lower brain stem of the cat by means of the fluorescence method showed CA neurons in the ventrolateral medulla at two levels: (1) one group of neurons in the caudal medulla, which lies ventral and dorsal to the lateral reticular nucleus (corresponding to area A1 in the rat); and (2) a second group found more cranially and located ventrally to the facial nucleus (corresponding to area A5 in the rat). CA nerve terminals in the spinal cord mainly innervate the intermediolateral cell column. From these findings it is concluded that in the anesthetized cat the spinal component of the somato-sympathetic reflex is modulated by a descending tonic inhibition. This inhibition is independent of baroreceptor input. The pathways descend in the dorsolateral funiculus of the spinal cord, and it is suggested that they originate either in the cranial part of area A1 and/or area A5.

Animals↗
PubMed1989

Intercostal blockade and pulmonary function after cholecystectomy.

Sixty-six patients undergoing cholecystectomy were randomly allocated to receive either intercostal blockade with bupivacaine supplemented with papaveretum or papaveretum alone for postoperative analgesia. Both groups were similar regarding distribution of sex, age, and weight. These two groups were compared. Patients who did not have intercostal blockade required postoperative analgesia sooner. There was no significant difference, however, in the total consumption of papaveretum. Both groups experienced similar degrees of pain, and there were no differences in postoperative pulmonary function. We conclude that although single intercostal blockade is an effective analgesic, it does not improve pain relief and does not improve pulmonary function after cholecystectomy when compared with a regimen of on-demand, intramuscularly administered papaveretum.

Analgesia↗
PubMed1984

[Extravascular lung water content following thoracic vagotomy. Experimental investigations in relation to the cause of pulmonary complications after surgery for esophageal cancer].

In order to investigate the relationship between postoperative pulmonary complications after surgery for esophageal cancer and surgical injury to the thoracic vagus nerves, changes of the extravascular lung water volume (EVLW) were studied in 26 mongrel dogs. Two protocols of experiment were designed as follows. In Experiment I (18 dogs), EVLW was measured before and on successive three days after thoracic vagotomy or sham operation. In Experiment II (8 dogs), responses of EVLW to the volume load of saline were studied in previously vagotomized or sham-operated dogs. The measurement of EVLW was performed by thermal-green dye double indicator dilution method. The results obtained were as follows. Values of EVLW as measured by thermal-green dye double indicator dilution method were extremely well correlated with those determined by gravimetric method. After vagotomy, EVLW increased successively. Rate of the increase was greater in dogs with bilateral vagotomy than in those with unilateral vagotomy on the right side. Measurement of various hemodynamics and oncotic pressure revealed no differences between vagotomized and sham-operated dogs. These observations suggested that the increase of EVLW was due to enhanced permeability of the pulmonary capillary wall. The volume load of saline resulted in increase of EVLW in vagotomized dogs, while no changes were observed in sham-operated dogs. The results of the current investigations indicate that the injury to the vagus nerves during surgery for esophageal cancer may induce water retention in the lung, which may be one of the underlying mechanisms of postoperative pulmonary complications.

Animals↗