SEARCH · PubMed Health

Results for “Autonomous surgery”

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.

At least 991 records · Page 55Linked to original sources

PubMed1997

Temporary loss of cardiac autonomic innervation after the maze procedure.

OBJECTIVE: Blunted sinus node response to exercise has been reported after the maze operation. We suggested the autonomic vegetative function of the heart to be disturbed after the maze procedure. METHODS: 17 patients, mean age 63 +/- 15 years, with chronic atrial fibrillation for 49 +/- 46 months (range 5-65) underwent the maze procedure during mitral valve surgery. Bicycle stress test, 24-h electrocardiography and heart rate variability were analysed in 11 patients after three and in six after 14 +/- 3 months. Spectral analysis within two frequency bands, vector analysis of the main circular resultant and influence of orthostasis and Valsalva manoeuvre on different R-R intervals were calculated. RESULTS: One patient died from a perioperative ischaemic stroke. At follow-up, all patients were in sinus rhythm. Heart rate reached 84 +/- 14%, the mean circular resultant was 60 +/- 48%, the ratio of the longest to the shortest R-R interval during the Valsalva manoeuvre was 92 +/- 8% and the ratio of maximal to minimal R-R interval after orthostasis was 98 +/- 4% of the age-adjusted normal value. Maximal workload was 116 +/- 31 watts. All patients had abnormal heart rate variability. Heart rate variability was significantly more blunted after three months, than after 14 months (P < 0.05). The minimal heart rate and the difference between the maximal and the minimal heart rate during the 24-h electrocardiography were significantly correlated to the number of normal physiological tests (r = -0.52; P < 0.05; r = 0.71; P < 0.005); for the maximal heart rate, there was a positive trend only (r = 0.44; P = 0.07). CONCLUSIONS: Early after the maze procedure, a nearly total denervation of the sinus node is present, similar as seen after heart transplantation, with partial restoration of the autonomic function after one year. The exercise capacity of the patients was satisfactory.

Adult↗

PubMed2005

Heart rate increase in otherwise subclinical seizures is different in temporal versus extratemporal seizure onset: support for temporal lobe autonomic influence.

Ictal heart rate was investigated in otherwise subclinical epileptic seizures to test the hypothesis as to whether ictal tachycardia is physiological and not a physical or psychological stress response. In addition, we aimed to evaluate the localizing significance of pure ictal tachycardia. We included 21 epilepsy patients, who showed an ictal EEG seizure pattern during 22, otherwise subclinical seizures. All patients underwent ictal video-EEG recordings to evaluate the possibility of resective epilepsy surgery. The changes in heart rate in these patients were investigated in order to determine their relationship to localization and duration of EEG seizure patterns. Ictal tachycardia was observed in 41% of the otherwise subclinical seizures (nine out of 22), and significantly more often in seizures arising from the temporal lobe than from extratemporal regions (62% versus 11%, p < 0.0018). The seizure duration as defined by EEG was significantly positively correlated with an increase of heart rate (p = 0.043). Ictal heart rate can increase as a result of epileptic activation of autonomic cortex, reflecting a temporal lobe autonomic influence. Thus, measurement of heart rate should be included in the evaluation of otherwise subclinical epileptic seizures, because of its localizing value.

Adolescent↗

PubMed1977

[Anaesthetic methods for surgery of cerebral aneurysms (author's transl)].

The anaesthetist giving anaesthesia for the surgical removal of cerebral aneurysms faces a great variety of tasks. Experience gained in the course of 61 such operations has shown that a combination of controlled hypotension, careful monitoring of the function of the autonomic nervous system and a meticulous surgical technique with the aid of a microscope produces satisfactory results.

Anesthesia, General↗

PubMed1986

Cushing's syndrome resulting from primary pigmented nodular adrenocortical disease.

In a 10-year-old boy with Cushing's syndrome, the dexamethasone suppression test, the metyrapone test, and both basal and corticotropin-releasing factor-stimulated corticotropin levels all indicated a primary adrenal disorder. However, a computed tomographic scan failed to detect an adrenal tumor. At surgery, the adrenal glands were not enlarged but were studded with small pigmented nodules composed of enlarged nonmalignant adrenocortical cells. This unusual abnormality, referred to as primary pigmented nodular adrenocortical disease, is associated with autonomous hypersecretion of cortisol primarily in children and young adults. Our patient was cured by total bilateral adrenalectomy and corticosteroid replacement therapy, the treatment of choice for this condition.

Adolescent↗

PubMed1993

Altered alpha 1-adrenoceptor binding in intact and adrenalectomized obese Zucker rats (fa/fa).

While many autonomic and metabolic defects associated with genetic obesity in the Zucker rat are corrected by adrenalectomy (Adx), brain adrenoceptor function has not been examined in this context. Here, 3 weeks after Adx or sham surgery, brains of 11 weeks old lean (Fa/Fa) and obese (fa/fa) male Zucker rats were assayed for alpha 1-([3H]prazosin; [3H]PRZ) and alpha 2-adrenoceptor ([3H]paraminoclonidine; [3H]PAC) binding by autoradiography. By genotype, obese rats had 19-256% higher [3H]PRZ binding than lean rats in the amygdala (central [ACN], basolateral [ABL], basomedial [ABM] and medial [MAN] nuclei [n.]), hypothalamus (dorsomedial n. [DMN] and lateral [LH]) and somatosensory cortex. In the ABL and ACN, increased maximal binding (Bmax) in obese rats was associated with decreased affinity (increased Kd). Three weeks after surgery, sham-operated obese rats gained 27% more weight than lean rats but lean and obese Adx rats gained the same amount of weight. Adx reduced [3H]PRZ binding in both lean and obese rats by 37-70% in the amygdala (ABM, ACN, MAN) compared to sham-operated rats. But, Adx selectively reduced [3H]PRZ binding only in lean rats in the ABL, DMN, ventromedial hypothalamic n. (VMN) and ventroposteromedial thalamic n. In most areas, decreases in maximal binding (Bmax) associated with Adx were accompanied by decreases in Kd. Unlike [3H]PRZ binding, there was no consistent genotype difference in [3H]PAC binding although Adx was followed by increased binding in obese and decreased binding in lean rats in the ABL. In only the VMN, obese rats had a 21% higher alpha 2- to alpha 1-adrenoceptor ratio than lean rats.(ABSTRACT TRUNCATED AT 250 WORDS)

Adipose Tissue↗

PubMed1975

Effects of pentolinium on blood sugar and serum potassium concentrations during anaesthesia and surgery.

Blood surgar and serum potassium (K+) concentrations were measured before, during and 60 min after surgery in two groups of 10 non-diabetic patients during nitrous oxide/halothane/tubocurarine anaesthesia. In the control group the arterial pressure was maintained within the patients' normal ranges, while in the study group pentolinium was administered i.v. (average 22 mg per patient) to achieve and maintain a mean arterial pressure of 50 mm Hg (+/-10 SEM). In the normotensive group the blood sugar concentration increased markedly and significantly during surgery and in the early postoperative period while the serum K+ concentration was essentially unchanged. In the hypotensive group pentolinium produced a striking modification of the surgery-induced hyperglycaemic response (but not to hypoglycaemic values) as well as a small but significant decrease in serum K+ concentration. The observed increase in the blood sugar concentration may be part of the autonomic response to surgical stress. Two mechanisms can explain the reduction in serum K+ concentration: (1) decreased hepatic glycogenolysis and (2) attenuation of the suppressive effect of adrenaline on insulin release, both effects being secondary to the ganglion-blocking property of pentolinium. These results are in contrast to the widely held belief that ganglion-blocking drugs cause hypoglycaemia.

Adult↗

PubMed1987

Characteristics and survival of diabetic patients undergoing vitreous surgery.

Characteristics, and the occurrence of other diseases, and complications related to diabetes mellitus of 91 consecutive diabetic patients who underwent vitreous surgery in 1979-1985 were examined. The mean age of the patients was 40 years (median 37, range 19-74), and the mean duration of diabetes 23 years (range 5-44). All, but one, had insulin therapy. Abnormalities in the cardiovascular and/or renal function were found in 89 of the 91 patients (98%). Signs of cardiovascular disease were observed in 58 patients (64%): 42% had elevated blood pressure (greater than or equal to 150/100 mmHg), 46% were on antihypertensive therapy, 14% had a history or signs of ischaemic heart disease, 12% had been digitalized, 7% had a history of cerebral ischaemia, and 8% had had surgery for gangrene of the lower limb. Signs of nephropathy were recorded in 64 patients (70%); 6 of them were on dialysis therapy, and two had received a kidney transplant. Symptoms possibly related to autonomic neuropathy e.g. postural hypotension, urinary tract symptoms, and gastric discomfort were found in 27%. Nine patients (10%) had some kind of thyroid disease, and two of them signs of multiple autoimmune endocrinopathy. The percentage surviving decreased from 96% at one year to 80% after 5 years of follow-up.

Adult↗

PubMed1995

Castration attenuates prolactin response but potentiates ACTH response to conditioned stress in the rat.

The purpose of this study was to examine the effect of circulating androgens on neuroendocrine, autonomic, and behavioral responses to stress. The effects of conditioned stress were studied in male Sprague-Dawley rats that were intact, gonadectomized, or gonadectomized and treated with dihydrotestosterone (DHT). Intact animals received sham surgeries. Animals were stressed 3 wk after surgery. The adrenocorticotropic hormone (ACTH) response to conditioned stress was significantly potentiated (P < 0.01) in gonadectomized males compared with sham-operated and gonadectomized DHT-treated animals. In stressed rats, plasma corticosterone levels were significantly higher (P < 0.05) in gonadectomized animals compared with DHT-treated castrates. The prolactin response to stress was decreased (P < 0.01) in gonadectomized males compared with sham-operated and gonadectomized DHT-treated rats. The stress-induced increases in plasma renin activity and concentration were not altered in gonadectomized or in gonadectomized DHT-treated animals. Nonstressed DHT-treated castrates exhibited more "fearlike" behavior compared with nonstressed sham-operated and gonadectomized animals. However, conditioned stress produced the same behavioral effects in all treatment groups. The results demonstrate that the ACTH/corticosterone, prolactin, and behavioral responses to a psychological stressor are differentially regulated by circulating androgens.

Adrenocorticotropic Hormone↗

PubMed2000

Subclinical Cushing's syndrome in patients with adrenal incidentaloma: clinical and biochemical features.

Incidentally discovered adrenal masses are mostly benign, asymptomatic lesions, often arbitrarily considered as nonfunctioning tumors. Recent studies, however, have reported increasing evidence that subtle cortisol production and abnormalities in the hypothalamic-pituitary-adrenal (HPA) axis are more frequent than previously thought. The purpose of this study was to investigate the clinical and hormonal features of patients with incidentally discovered adrenal adenomas, in relation to their clinical outcome. Fifty consecutive patients with incidentally detected adrenal adenomas, selected from a total of 65 cases of adrenal incidentalomas, were prospectively evaluated. All of them underwent abdominal computed tomography scan and hormonal assays of the HPA axis function: circadian rhythm of plasma cortisol and ACTH, urinary cortisol excretion, 17-hydroxyprogesterone, androgens, corticotropin stimulation test and low-dose (2 mg) dexamethasone test. The patients were reevaluated at regular intervals (6, 12, and 24 months) for a median period of 38 months. Subtle hypercortisolism, defined as abnormal response to at least 2 standard tests of the HPA axis function in the absence of clinical signs of Cushing's syndrome (CS), was defined as subclinical CS. Mild-to-severe hypertension was found in 24 of 50 (48%) patients, type-2 diabetes in 12 of 50 (24%), and glucose intolerance in 6 of 50 (12%) patients. Moreover, 18 of 50 patients (36%) were diffusely obese (body mass index, determined as weight/height2, > 25), and 14 patients (28%) had serum lipid concentration abnormalities (cholesterol > or = 6.21 mmol/L, low-density lipoprotein cholesterol > or = 4.14 mmol/L and/or triglycerides > or = 1.8 mmol/L). Compared with a healthy population, bone mineral density Z-score, determined by the DEXA technique, tended to be slightly (but not significantly) lower in patients with adrenal adenoma (-0.41 SD). Endocrine data were compared with 107 sex- and age-matched controls, and patients with adenomas were found to have heterogeneous hormonal abnormalities. In particular, significantly higher serum cortisol values (P < 0.001), lower ACTH concentration (P < 0.05), and impaired cortisol suppression by dexamethasone (P < 0.001) were observed. Moreover, in patients with adenomas, cortisol, 17-OH progesterone, and androstenedione responses to corticotropin were significantly increased (P < 0.001, all), whereas dehydroepiandrosterone sulfate levels were significantly lower at baseline, with blunted response to corticotropin (P < 0.001, both). However, the criteria for subclinical CS were met by 12 of 50 (24%) patients. Of these, 6 (50%) were diffusely obese, 11 (91.6%) had mild-to-severe hypertension, 5 (41.6%) had type-2 diabetes mellitus, and 6 (50%) had abnormal serum lipids. The clinical and hormonal features improved in all patients treated by adrenalectomy, but seemed unchanged in all those who did not undergo surgery (follow-up, 9 to 73 months), except for one, who was previously found as having nonfunctioning adenoma and then revealed to have subclinical CS. In conclusion, an unexpectedly high prevalence of subtle autonomous cortisol secretion, associated with high occurrence of hypertension, diabetes mellitus, elevated lipids, and diffuse obesity, was found in incidentally discovered adrenal adenomas. Although the pathological entity of a subclinical hypercortisolism state remained mostly stable in time during follow-up, hypertension, metabolic disorders, and hormonal abnormalities improved in all patients treated by adrenalectomy. These findings support the hypothesis that clinically silent hypercortisolism is probably not completely asymptomatic.

17-alpha-Hydroxyprogesterone↗

PubMed2005

[Effects of the autonomic nervous system function on the course of postoperative period in surgical removal of vocal cords polyps with Nd:YAG-laser].

The study of the effects of autonomic nervous system (ANS) function on the course of the postoperative period after removal of the vocal cord polyps with Nd:YAG laser has shown that laryngeal operations with utilization of Nd:YAG laser accelerate normalization of structural-functional condition of the vocal cords in patients with adequate autonomic support by 25-40 days compared to those with inadequate ANS function.

Autonomic Nervous System↗

PubMed1994

Acute intermittent porphyria: clinical analysis of nine cases.

BACKGROUND: Acute intermittent porphyria (AIP) is an uncommon disorder, characterized by a variety of nonspecific symptoms and signs. Many patients have undergone prolonged medical care for the condition without accurate diagnosis; some have even received unnecessary operation. Here the clinical features of nine cases are presented. METHODS: Nine patients with AIP were diagnosed and treated at this hospital during the period for 1986 to 1993. The medical records of these patients were reviewed, and diagnosis of AIP in all cases was confirmed by positive Watson-Schwartz test. In three cases, further confirmation was done with erythrocyte porphobilinogen (PBG) deaminase activity measurement. Patients with photosensitivity were excluded. RESULTS: All patients presented initially with abdominal pain; two had been operated upon for acute abdomen. Neurological presentations at diagnosis were motor and/or sensory polyneuropathy (6/9), autonomic dysfunction (6/9), mental change (5/9) and seizure (4/9). Two cases had hyponatremia. One patient died of intractable seizures. CONCLUSIONS: AIP is a frequently forgotten old disease; if not correctly recognized, repeated and unnecessary surgery may occur. However, the diagnosis is easy when the possibility of this disorder is kept in mind.

Acute Disease↗

PubMed1976

[Gastrointestinal hormones].

Gastrointestinal hormones are considered to be those that are formed in the gastrointestinal tract and there, in physiological concentrations, develop their effects on motility, secretion, trophism, bloodflow and absorption. Structural analysis, synthesis or a high degree of purity after extraction, and its exact demonstration by means of a useful radioimmunoassay, form the basis for the establishment of a polypeptide as a gastrointestinal hormone. To this category belong, at the present time, gastrin, cholecystokinin-pancreozymin (CCK-PZ) and secretin. GIP, VIP, motilin, glucagon and somatostatin are considered likely candidates. The substances gastrin and CCK-PZ, which are structurally related and have a predominantly stimulating effect, and the structurally dissimilar motilin, contrast with the partially or totally inhibiting hormones of the glucagon family, namely, secretin, VIP, glucagon-enteroglucagon, GIP and somatostatin. By the combined action of these hormones with one another and with the autonomic nervous system, the digestive processes are regulated. Disturbances in the formation of these hormones, in particular an overproduction, give rise to disease syndromes that can now be diagnosed and, in part, treated by surgery. The therapeutic application of gastrointestinal hormones has now also become a possibility.

Cholecystokinin↗

PubMed1992

[Malignant tumor of the autonomic nervous system of the stomach (GAN-tumor)--case report of a new entity].

Gastrointestinal autonomic nerve (GAN)-tumors are extremely rare. So far seven cases of intestinal and four of gastric GAN-tumors were reported. GAN-tumors, also termed plexosarcomas, arise from autonomic nervous system plexuses of the gastrointestinal tract such as those of Meissner or Auerbach. We report a case of a metastatic gastric GAN-tumor in a 40-year-old woman. A small, 1 cm in diameter, submucosal plexosarcoma located in the posterior gastric wall and a 1.5 kg, 23 x 15 x 11-cm metastasis located retroperitoneally behind the stomach between liver, spleen and pancreas without discernable invasion of any of these organs were found. En-bloc resection of the retroperitoneal mass, the spleen, the pancreatic tail, and a part of the posterior gastric wall adhering to the mass were performed. In addition, lymph node metastases in splenic hilum were noted, and resected. In CT scan liver metastases were detectable fourteen months after surgery. The diagnosis is based on light microscopical, ultrastructural, and immunhistochemical analyses. The prognosis of GAN-tumors is fatal. In spite of radical excision 8 of 11 reported patients died few month after surgery while local recurrences and/or metastases in regional lymph nodes and in the liver were found. The response to chemotherapy was poor.

Adult↗

PubMed1990

[Significance and diagnosis of autonomic neuropathy in diabetes].

The results of studies performed to date would appear to show that autonomic neuropathy (ANP) in diabetics can involve any organ system. The earliest and most common manifestation is seen in the cardiovascular system, and finds expression as orthostatic phenomena, resting tachycardia, and "rigid pulse". Simple, non-invasive tests permit accurate quantification and follow-up. ANP in the gastrointestinal tract manifests as a motility disturbance, and the resulting delay in absorption might be the cause of inexplicable blood sugar fluctuations. A phenomenon of decisive importance for the diabetic is the lowering of his awareness of a hypoglycemic state. For this reason, intensive training of the diabetic in the self-determination of blood sugar and requirement-matched insulin dosage are thus of extreme importance. Disturbances of sexual function, which are all too rarely mentioned, usually put a heavy strain on the diabetic. Medical care of diabetics prior to, during and after surgery should give due consideration to cardiac, pulmonary and gastrointestinal ANP involvement. In view of the limited therapeutic possibilities, prevention of ANP should receive top priority.

Autonomic Nervous System Diseases↗

PubMed1991

Autonomously functioning thyroid adenoma in a seven year old boy.

Hyperfunctioning thyroid adenoma is an extremely rare disorder in childhood. A case of a seven year old boy is reported. Clinical and laboratory findings were similar to those seen in adults. Recovery of thyroid function was prompt after ablative surgery and no substitutive therapy was required.

Adenoma↗

PubMed1999

Spinal block levels and cardiovascular changes during post-Cesarean transport.

PURPOSE: Transport after surgery under spinal anesthesia is associated with cardiovascular changes. The extensively vasodilated patient may be unable to compensate for postural blood flow redistribution. This observational study investigated pre- and post-surgery sensory levels as well as hemodynamic changes during the postoperative transfer period. METHODS: One hundred ninety nine women, ASA 1 and 2, undergoing Cesarean section under spinal anesthesia were studied at the end of surgery. Hyperbaric bupivacaine 12-15 mg and morphine 0.25 mg were the agents used. Patients in group A (n = 111) were transferred to the Recovery Room on a stretcher with the upper body flexed 30 degrees head up: patients in group B (n = 88) remained supine during transport. RESULTS: At the end of Cesarean section 95% of patients had upper sensory levels of T4 and higher. In 17.5% the block ascended 2-7 dermatomes compared with the pre-operative level. The incidence of hypotension on arrival in Recovery Room was similar in both groups (group A 10% and group B 9%). CONCLUSION: These results draw attention to the persistence of extensive sympathetic block at the end of Cesarean section. Transport to the Recovery Room was associated with the development of considerable hypotension in 10% of patients and this was unaffected by position. We recommend recording the level of sensory block at the end of surgery and increased monitoring during transport to the Recovery Room.

Adult↗

PubMedDate not supplied

Success rate of unilateral spinal anesthesia is dependent on injection flow.

BACKGROUND AND OBJECTIVES: The dependence of unilateral spinal anesthesia on injection flow is controversial. We hypothesized that it is possible to achieve strictly unilateral sympathetic block (as assessed by temperature measurements of the limbs) and unilateral sensory and motor block, respectively, during spinal anesthesia by a slow and steady injection of a hyperbaric local anesthetic solution. METHODS: Forty-four patients (American Society of Anesthesiologists [ASA] physical status I-III) undergoing surgery of one lower extremity were randomly assigned to one of two groups. Dependent on the patients' height, 1.4 to 1.7 mL hyperbaric bupivacaine 0.5% was injected manually with the patient in the lateral decubitus position, which was maintained for 30 minutes after injection. Injection flow was approximately 0.5 mL/min in group I ("air-buffered" injections performed by 4 mL air between the local anesthetic and the syringe's plunger, n = 25) and approximately 7.5 mL/min in group II ("conventional" injections, n = 19). Sympathetic block was defined as a temperature increase of more than 0.5 degrees C at the foot. Any reduction in the ability to move the hip, knee, or ankle as well as loss of temperature discrimination and/or pinprick even in one dermatome on the nondependent side was considered as a bilateral block. RESULTS: Before surgery, significant differences (P < .05) were observed for unilateral motor paralysis (92% in group I v 68.4% in group II), unilateral sensory block (48.0% v 10.5%), and unilateral sympathetic block (72% v 42.1%). Strictly unilateral spinal anesthesia was found to be significantly more frequent in group I (40% v 5.3%). Significant hemodynamic differences between the groups were not detected. CONCLUSIONS: For hyperbaric spinal anesthesia, the injection flow is an important factor in achieving unilateral sympathetic block. A slow injection proves useful to restrict spinal anesthesia to the side of surgery.

Adolescent↗

PubMed1992

Continuous coeliac plexus blockade plus intermittent wound infiltration with bupivacaine following upper abdominal surgery: a double-blind randomised study.

In this double-blind trial, we observed the effect of intermittent wound infiltration with local anaesthetic plus continuous coeliac plexus blockade on postoperative pain relief, pulmonary function, the neuroendocrine and acute phase protein response following upper abdominal surgery. In Group A (n = 10) patients received bupivacaine intermittently into the wound and continuously into the coeliac plexus following an initial bolus. A total of 862.5 mg of bupivacaine was used over 12 h with no observed toxicity. Group B (n = 10) received equal volumes of saline. Although pain relief was poor in both groups, the bupivacaine group used less morphine postoperatively and had lower pain scores than the saline group 4 h after operation (P less than 0.05). Pulmonary function was significantly reduced in both groups with no statistical difference between the two. Significant reductions in serum glucose and cortisol were achieved (P less than 0.05), suggesting that afferent neural blockade was partially effective in attenuating the neuroendocrine response. However, the postoperative rise in interleukin-6 was not affected by this technique. It is concluded that total afferent neural blockade cannot be achieved with peripheral wound and coeliac plexus administration of relatively large doses of local anaesthetic during upper abdominal surgery.

Abdomen↗