SEARCH · PubMed Health
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Explore the source record for details and available documents.
OBJECTIVE: To evaluate the advantages of the ultrasonic scalpel compared to electrocoagulation in patients undergoing video-assisted thoracoscopic sympatholysis or sympathectomy for uncontrolled facial blushing. METHODS: Two hundred bilateral video-assisted thoracoscopic procedures to interrupt transmission in the thoracic sympathetic nerve were performed in 100 patients with incapacitating facial blushing. In 2 cases, the video-assisted approach was chosen because of pleural symphysis. The mean age of patients was 34 years (range: 15 to 67). The sympathetic chain was interrupted from the lower portion of the first thoracic ganglion through the third. RESULTS: All patients were discharged within 24 hours with the exception of one on whom an emergency thoracotomy had been performed. No complications were reported in the group in which a harmonic scalpel was used. One case of temporary Horner syndrome (4 months) and 3 cases of persistent chest pain (more than 2 weeks) were reported in the diathermy group. There were 9 cases of partial and asymptomatic pneumothorax that resolved without treatment or prolonged hospital stays. CONCLUSION: Dissection of the sympathetic nerve is accomplished more reliably and with better visualization with the ultrasonic scalpel. Peripheral lesions in lung parenchyma and adjacent tissues (intercostal vessels and nerves) are avoided, as is Horner syndrome, which can be caused by dispersion of heat. Use of the ultrasonic scalpel would also lead to a lower incidence of postoperative neuralgia.
Thoraco-abdominal oseophagus was removed in continuity with the stomach during autopsy of 30 patients--two patients had undergone troncular vagotomy and pyloroplasty, the other 28 had not been operated on. In 22 cases (including the 2 which had undergone vagotomy) one or more branches of the thoracic vagus nerve existed. These branches (intramural nerves) reached the stomach after passing for 1.5 to 10 cm between the two muscular layers (of the oesophagus). They originated more often from the anterior (18) than from the posterior vagus nerve (-6). Intramural nerves are spared during abdominal vagotomy: are they the cause of some therapeutic failures of vagotomy?
The reason to consider the second thoracic cerebrospinal nerve (Th2) as one of the sources of the brachial plexus is the fact of the intersegmentary connection between Th1 and Th2 by means of a neural branch situating on the internal surface of the thorax near the vertebral column (the intrathoracic or paravertebral branch). However, not all cases of the intersegmentary connection Th1-Th2 should be regarded only as participation of Th2 in the formation of the brachial plexus, this is conditioned by certain peculiarities of its structure and by the character of interconnections with the I intercostal nerve. The macro-microscopic method demonstrates that the intersegmentary connection Th1-Th2 includes somatic and vegetative components, that to the same extent participate both in formation of the brachial plexus and in the I intercostal nerve. The intersegmentary connection Th1-Th2 is considered as a vegetative neural structure, containing somatic conductors and is considered as a homologue of superficial connective branches. It is the way, by which sympathetic fibers can reach the brachial plexus from the segment situating below, without passing through the superior thoracic nodes of the sympathetic trunk.
Explore the source record for details and available documents.
A brief review is given of experimental studies on 'apneusis' (Lumsden) and the role these have played in the conceptual development of the ideas relating to the nervous mechanism of breathing. It is suggested that the terms "apneustic," "pneumotaxic," and "respiratory" (inspiratory or expiratory) centers should be abandoned in view of the convoluted epistemology of the concepts they represent. New experiments on expiratory apneusis are described, involving sagittal incisions of the brain stem in the vicinity of the obex, which have allowed study of the brain stem-mediated effects of CO2 on expiratory motoneurons, under steady-state conditions. These experiments reveal the existence of a CO2-dependent tonic excitation of expiratory motoneurons that, it is argued, depends on a simple pathway between peripheral and central chemoreceptors and expiratory bulbospinal neurons. The possible synaptic mechanisms underlying the production of CO2-dependent appneusis are discussed in relation to peripheral chemoreceptors and illustrated in relation to a model motoneuron.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Chest pain of esophageal and cardiac origin is often difficult to distinguish due to similar sensations and localization. We have shown that spasm-like contractions of the spinotrapezius muscles evoked by noxious cardiac stimulation could potentially sensitize muscle afferent fibers and produce angina-like referred pain. In this study, we proposed that a similar type of spinotrapezius contraction evoked by esophageal stimulation could produce nociceptive responses with similar quality and localization as evoked by cardiac stimulation. An objective of this study was to show convergence of pathways to the spinotrapezius muscles by measuring electromyographic (EMG) activity between the cardiac- and esophageal-motor reflexes. We also investigated afferent pathways of esophageal-motor reflexes by disrupting or activating the left sympathetic chain and vagus nerves; these pathways form the afferent limbs of the cardiac-motor reflexes. Results showed that more than 95% of animals responding to noxious cardiac stimulation also responded to esophageal distension. Transection of the left sympathetic chain to reduce upper thoracic visceral afferent innervation significantly decreased cardiac-evoked EMG activity or total motor unit potentials (t-MUP). In contrast, however, the transection did not significantly decrease t-MUP evoked by esophageal distension. Bilateral vagotomy and vagal afferent stimulation increased and decreased the cardiac-evoked t-MUP, respectively. However, the same vagal manipulations did not influence t-MUP evoked by esophageal distension. This study demonstrated that the spinotrapezius muscle could be activated by noxious stimulation of two different visceral organs. The spinotrapezius muscle contractions evoked by esophageal distension are produced in part by activation of esophageal afferent fibers found in upper thoracic sympathetic nerves, but not by activation of the vagus nerves.
Explore the source record for details and available documents.
The question as to whether anastomosis of sensory nerves is recommended for free transplants of the myocutaneous latissimus dorsi flap, reanastomosed by microvascular surgery, remains a controversial issue. In this study, a microsurgical nerve anastomosis was performed to sensitize a latissimus dorsi transplant. To determine sensation in the transplanted tissue, six patients were examined clinically. All patients had free transplants of latissimus dorsi flaps reanastomosed by microvascular surgery after tumor resection in the oral cavity. An anastomosis of the sensible auricular magnus nerve with the motor thoracodorsalis nerve was performed. Resulting sensation was determined clinically by testing for pain, temperature, pressure, two-point discrimination, and vibration. All patients showed sensation in the latissimus dorsi flap beginning between the third and the fifth month postoperatively. Therefore, resensitization of a large and voluminous myocutaneous latissimus dorsi flap should be attempted by a nerve anastomosis in this transplant.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
OBJECTIVE: The hypothesis was tested that preoperative multiple-injection thoracic paravertebral blocks reduce opioid requirements and promote early ambulation after video-assisted thoracic surgery procedures. DESIGN: Prospective, randomized, controlled, blinded study. SETTING: Single-university hospital. PARTICIPANTS: Fifty consenting patients undergoing video-assisted thoracic surgery. INTERVENTIONS: Patients were randomly assigned to receive preoperative multiple-injection thoracic paravertebral blocks (PVB group, n = 25) or preoperative multiple subcutaneous saline injections at the same site as in the PVB group (control group, n = 25). MEASUREMENTS AND MAIN RESULTS: Intraoperative fentanyl consumption was lower in the PVB group (p < 0.01). The time to first analgesic requirement was longer, and pain score at this time was lower in the PVB group (p < 0.05 and p < 0.01, respectively). Postoperative pain scores both at rest and coughing were lower during the first 4 hours in the PVB group than those in the control group (p < 0.01 for 0 hours and p < 0.05 for 1, 2, and 4 hours). Cumulative morphine consumption was significantly less in the PVB group at all time points (p < 0.05 for 12 hours and p < 0.01 for all other time points), but there were no significant differences in sedation scores between the 2 groups. There were no complications because of the blocks. Patient satisfaction with the analgesia was significantly greater (p < 0.05), and first mobilization and hospital discharge were quicker (p < 0.01 and p < 0.05, respectively) in the PVB group. CONCLUSION: Perioperative multiple-injection thoracic paravertebral blocks with bupivacaine containing epinephrine provided effective pain relief and a significant reduction in opioid requirements. This approach may also contribute to earlier postoperative ambulation after video-assisted thoracic surgery.
Twelve cadavers were dissected for the study of the cervicothoracic junction. The results showed that the mean heights and widths of the ganglia tend to decrease from the C-6 to T-4 nerve. The mean distances between the dura and the ganglion and the mean spinal nerve angles increased consistently from C-5 to T-4. The mean distances from the spinal nerves to the superior and inferior pedicles ranged 0.8-2.3 mm. It was noted that the mean value was significantly greater for the distance from the spinal nerve to the superior pedicle than that to the inferior pedicle for the spinal nerves C5-7 (P< or =.05). This information, in conjunction with imaging studies, may minimize spinal nerve injury during posterior pedicle screw fixation in the cervicothoracic spine.
Modified radical mastectomy with preservation of one or both pectoral muscles is the surgical treatment of choice in stage I and II breast cancer. A surgical anatomic study has been performed, based on post-mortem and intraoperative findings, to investigate origin and course of lateral and medial pectoral nerves and their relations to pectoral muscles and axillary lymphonodes. The results suggest that Patey-Meier operation can produce, in 80 per cent of cases, atrophy and fibrosis of the costoabdominal portion of the pectoralis major muscle as lateral pectoral nerve is generally dissected. On the contrary, radical mastectomy with both pectoral muscles preservation permit also to preserve the nerves during lymphadenectomy if they are recognized.
Explore the source record for details and available documents.