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PubMed1990

Chronic cluster headache managed by nervus intermedius section.

Cluster headache sufferers who become candidates for surgical treatment are those relatively rare patients who are refractory to all attempts at pharmacological relief. Ablative surgical procedures have been directed against either the trigeminal nerve or the nervus intermedius/greater superficial petrosal (NI/GSP) pathway. Both carry nociceptive impulses from the head and face, and the NI also carries parasympathetic fibres which appear to be responsible for the autonomic concomitants of cluster headache. Trigeminal operative procedures are not consistently helpful in chronic cluster headache, while NI section has been shown to give potentially long lasting relief but carries the potential risks of cerebellopontine angle surgery. In eight selected cases of chronic cluster headache we have demonstrated a high early success rate for pain relief, with few complications, in the performance of NI section, combined, when indicated, with microvascular decompression of the trigeminal main sensory root. We believe that cochlear nerve monitoring helps prevent postoperative hearing impairment. An intimate relationship between the NI and arterial loops of the anterior inferior cerebellar artery (AICA) or the internal auditory artery has been frequently observed in our chronic cluster headache patients.

Adult↗
PubMed1996

Halothane and cardiac autonomic control in infants: assessment with quantitative respiratory sinus arrhythmia.

In comparison to adults, infants undergoing halothane anesthesia have an increased incidence of clinically significant episodes of bradycardia, hypotension, and cardiac arrest. To examine potential cardiac autonomic regulatory mechanisms that may account for these observations, the relationship between respiratory activity and short-term variations of heart rate was quantified in 10 healthy term nonpremedicated infants (28.4 +/- 0.6 wk old) undergoing elective surgery with halothane and low caudal anesthesia. Quantitative respiratory activity, heart rate, and cuff blood pressure data were obtained during the preoperative awake period, and at three depths of halothane--1, 1.3, and 2.0 mean alveolar concentration (MAC). Time and frequency domain analyses were performed on two 2.2-min epochs of data from each condition to yield mean values, spectral measures of low (0.02-0.15 Hz) and high (0.15-0.80 Hz) frequency power (LF and HF), and the LF/HF ratio. The sympathetic (As) and parasympathetic (Ap) components of respiratory sinus arrhythmia were quantified using the transfer relations between respiration and heart rate to derive gain factors Ax and Ap, respectively. Mean heart rate, blood pressure, and respiratory activity all decreased with halothane exposure (p < 0.01), but did not differ by halothane dose. Similarly, LF, HF, LF/HF, and respiratory powers all decreased with halothane, but not between doses. When the effects of respiratory activity on heart rate were accounted for, As decreased at 1.3 and 2.0 MAC only, but Ap remained unchanged. Decreased LF and HF power suggests that halothane altered both sympathetic and parasympathetic heart rate control; however, when the ratio between LF and HF and the quantitative effects of respiration are accounted for, halothane appears to cause a reduction in respiratory related sympathetic heart rate control, without a significant change in parasympathetic control.

Anesthetics, Inhalation↗
PubMed1988

[Mexico: comparative evaluation of 2 study plans for the career of surgeon. Academic effectiveness].

The authors discuss an experiment conducted at the Zaragoza National School of Professional Studies of the Autonomous National University of Mexico (ENEP-Zaragoza). This experiment, already reported in a previous issue of this quarterly, consisted of the simultaneous application of two different curricula for studies leading to a medical degree in surgery. In this second article, the authors discuss the process used in evaluating the current curricula, which were assessed from three standpoints: theory and concept; academic effectiveness, and a follow-up on graduates. They describe the methodology used and analyse the findings. Their conclusion is that with the modular curriculum, the students obtained a greater command of their professional functions at an earlier stage, than with the curriculum organized by subject matter. These observations are corroborated by the fact that there are academic differences between students taught according to different educational models and curricula. On the basis of these and other significant facts, the authors state that the modular plan of studies is better suited to the country's health needs, since it trains medical students to deal with the health problems of higher-risk groups (maternal and child care).

Curriculum↗
PubMedDate not supplied

[Surgical treatment of hyperthyroidism].

The most important problems of hyperthyroidism surgery are: the correct indication of operation, the choice of the best moment for operation and at last the extension of the resection. The authors experience include 365 patients with hyperthyroidism; 201 of them had monolateral autonomous nodules, 82 had diffuse multinodular goitre and 79 had Graves disease. In the first group of patients surgical treatment was total extracapsular isthmo-lobectomy, in the second group was performed subtotal thyroidectomy and in the third group was almost performed near-total thyroidectomy. Three relapses were found: two of that regarded patients with autonomous function nodule and one in patient with Graves disease. In 201 patients with toxic monolateral hyperfunction of the node, an extracapsular isthmo-lobectomy was performed. In the greater part of the 82 multinodular goiter cases a sub-total thyroidectomy was performed, as well as in 79 patients with Graves disease. Among the 3 recidive cases of hyperthyroidism (0.8%) one was recorded in a patient with Graves disease, (after subtotal thyroidectomy) and two in patients with hyperfunction of the node, (after isthmo-lobectomy). The authors justify the low incidence of recurrence by the choice of large extension of resection without a great number of complications.

Goiter↗
PubMed1997

[Differentiated thyroid carcinomas manifesting as toxic adenoma].

BACKGROUND: Hot thyroid nodules are generally benign. We report two exceptional cases of thyroid carcinomas mimicking toxic adenomas. CASE REPORTS: A 35-year-old man and a 55-year-old woman had thyroid carcinoma behaving as an autonomously hyperfunctioning nodule. DISCUSSION: Only twenty similar cases have been reported in the literature. While a hot nodule on radio-iodine scan is unlikely to be malignant, the possibility of carcinoma should not be overlooked. Surgery should therefore be the preferred treatment of toxic adenoma.

Adult↗
PubMed1993

Classification of autonomic disorders.

Recent advances in our understanding of the pathophysiology of cardiovascular regulation and the metabolism of catecholamines have enabled us to develop an improved system of classification of autonomic disorders. Patients with autonomic impairment, clinically unassociated with other neurological abnormalities, are considered to have the Bradbury-Eggleston syndrome (idiopathic orthostatic hypotension, pure autonomic failure). Individuals whose autonomic failure is accompanied by degeneration in other neurological systems are classified as having the Shy-Drager syndrome (multiple system atrophy with autonomic failure). Patients in whom a deficiency of the enzyme dopamine-beta-hydroxylase is present from birth have many features suggestive of the Bradbury-Eggleston syndrome but manifest normal sweating and biochemically have an elevated plasma and urinary dopamine level. Recognition of these individuals is of particular importance because they are uniquely responsive to treatment with oral dihydroxyphenylserine (L-DOPS). A fourth disorder is baroreflex failure; this disorder is usually due to surgery, trauma, radiation or other injury to the ninth or tenth cranial nerves or the medullary nuclei which their fibers innervate. Patients with baroreflex failure have oscillations between hypertension and hypotension, but these alterations are poorly correlated with posture. Very high levels of plasma norepinephrine are found during the hypertensive phase of baroreflex failure. Baroreflex failure is generally responsive to treatment with clonidine. In conclusion, the diagnosis and therapy of autonomic disorders has improved due to the more precise taxonomy now current.

Autonomic Nervous System Diseases↗
PubMed2000

[Malignant tumors of the gastrointestinal autonomic nervous system (GAN tumors or plexosarcomas). Report of a case].

The plexosarcomas or gastrointestinal autonomic nerve tumors (GAN tumors) are very rare neoplasms originating from the gastrointestinal autonomic nervous system. They have been differentiated from the other gastrointestinal stromal tumors due to ultrastructural features showed by electronic microscopy. Their mesenteric localization rare than the gastric and intestinal localization, and it gives a very poor and specific clinical symptomatology. It's very difficult to make a correct diagnosis. The most important prognostic factors influencing the survival seem to be the tumor size and the mitotic activity. The authors describe a case of multiple Plexosarcomas occurred in a young patient one year after a surgical intervention for ileal resection to remove a benign schwannoma. This patient wasn't a carrier of multiple Neurofibromatosis. The diagnostic difficulties before surgical operation are stressed and the importance of surgery as the only diagnostic and therapeutic choice is underlined, even if local recurrences occurred in more than 50% of the treated cases.

Adult↗
PubMed1996

Comparison of mammographic image quality in various methods of reconstructive breast surgery.

The purpose of our study was to evaluate mammographic image quality of various methods of reconstructive breast surgery with specific reference to the possibility of diagnosis of recurrent tumors. A total of 39 patients who underwent breast reconstruction following modified radical mastectomy were subject to clinical and mammographic examination. Three groups were formed: (a) autonomous tissue reconstruction (TRAM-flap; n = 9), (b) submuscular silicon gel prostheses (n = 21), and (c) supramuscular silicon gel prostheses (n = 9). Mammographic image quality of the groups was compared by two radiologists working together using a point system where five specific criteria were valued and scored. The result was tabulated into three quality levels: good, acceptable, and limited. Mammograms were assessed as good, acceptable, or limited, respectively, as follows: group I: 7 (77.8%), 1 (11.1%), 1 (11.1%); group II: 4 (19%), 11 (52.4%), 6 (28.6%); group III: 3 (33.3%), 4 (44.5%), 2 (22.2%). The TRAM-flap method of reconstruction displays a high degree of mammographic image quality and therefore is preferable with respect to early diagnosis of recurrent tumors.

Adult↗
PubMed1997

History of emphysema surgery.

Ever since the advent of modern chest surgery, surgical pioneers have attempted operations to alleviate, if not cure, patients with emphysema. From the physiologic standpoint illogical procedures such as costochondrectomy, phrenisectomy, or thoracoplasty lead to disastrous results, whereas the effect of operations on the autonomous nervous system was unpredictable. The only worthwhile procedure was bullectomy for localized bullous emphysema. The concept of volume reduction developed by Brantigan in the 1950s and rediscovered by Cooper is the only successful surgical approach to an essentially incurable pulmonary disease.

History, 20th Century↗
PubMed2001

Complex regional pain syndrome.

Despite its recommendation by the International Association for the Study of Pain, the term 'complex regional pain syndrome' has not been widely adopted. Most authors still prefer the term 'reflex sympathetic dystrophy'. The diagnostic criteria recommended by the International Association for the Study of Pain have been criticized as lacking specificity, and refined criteria have been proposed. The pathophysiology of the complex regional pain syndrome remains elusive, but most recent work favours a central mechanism both for the sensory features and the autonomic features. Peripheral mechanisms include tissue acidosis. Some investigators, however, view the condition as psycho-neurogenic. Although recommended by some, laboratory tests add little to diagnostic confidence. Certain prophylactic measures have been recommended for patients undergoing surgery, and for the treatment of fractures of the radius. Treatment is still based largely on traditional wisdom. Some new treatments have been promoted on the basis of uncontrolled studies. Controlled studies have indicated possible roles for bisphosphonates and spinal cord stimulation.

Journal Article↗
PubMed2005

Latex sensitivity awareness in preoperative assessment.

The role of the preoperative assessment practitioner (POAP) has evolved hugely to allow them to become more autonomous in decision-making, particularly in the design of local protocols and guidelines for preoperative assessment. Good practice guidelines are imperative to ensure that all requirements for the patient have been identified before the day of surgery, which minimises the risk of late cancellations.

Algorithms↗
PubMed2004

Data mart based research in heart surgery: challenges and benefit.

For many new medical research questions in heart surgery comprehensive and large data bases are essential. We discuss typical challenges for the integration of real-time and legacy data stored in multiple unconnected hospital information systems (HIS). Furthermore the HIS are often operated by autonomous departments whose data base structures are subject to occasional modifications. We present a solution which integrates and consolidates all research relevant data in a data mart without imposing any considerable operational or maintenance contract liability risk for the existing HIS. The problems of partial consistency and partial redundancy in the data are discussed. The data mart system serves multiple purposes: beside clinical reporting and quality assessment, the preparation steps for comprehensive studies are enormously simplified.

Biomedical Research↗
PubMed1989

[Dynamics of restoration of the motor and sensory functions of the upper extremity after suturing].

In 46 patients 63 nerves of upper extremities were sutured and clinico-electroneuromyographic investigations performed. The restitution of motor and sensory functions ran slowly over 7 to 36 months depending on the level injured. Full restoration of motor functions surpassed the restoration of sensory functions in the autonomic zone of the nerve lesioned. Electroneuromyographic investigation showed that clinical healing provides no real indices of the final nerve regeneration as the nervous condition velocity remained altered. This allows recommending nonsurgical treatment for several months after surgery under electroneuromyographic control.

Adult↗
PubMed1988

[Alternative tumor therapy].

Our knowledge about the biology of malignant growth has changed. The tumor cell is not absolutely autonomous. The reactions of the host organism are important (e.g. hormone-dependent tumors). The so-called alternative medicine has always been of this opinion. Some of its methods seem worthy of consideration in cases where surgery, X-ray therapy and cytostatics have doubtful results.

Complementary Therapies↗
PubMed1994

[Andrological complications after pancystoprostatovesiculectomy surgery: utility of the bulbocavernosus reflex].

The technique for radical cystoprostatectomy was modified to avoid injury to the branches of pelvic plexus that innervate the corpora cavernosa (monolateral neurovascular bundle preservation or "Nerve sparing technique"). The studies of Walsh and coll. demonstrated that the branches of pelvic plexus that innervate the corpora cavernosa are situated between the rectum and urethra and penetrate the urogenital diaphragm near to the muscular wall of the urethra. Injuries to the pelvic plexus can occur during 1) division of posterior pedicle of bladder (the seminal vesicle can be used as a landmark intraoperatively to avoid injury to pelvic plexus), 2) during apical dissection of prostate with transection of the urethra. The return of sexual function postoperatively is related to preservation of autonomic innervation; the excision of the neurovascular bundle on one side may prevent impotence in 68% patients. Our study was undertaken to identify the cause of impotence in men undergoing radical cystoprostatectomy with "Nerve sparing technique" using bulbo cavernous reflex. Our results suggest that bulbo cavernosus reflex may not be a sensitive clinical tool to establish a diagnosis of neurogenic erectile dysfunction after pelvic surgery. The Authors examine the recent neuro-uro-physiological diagnostic methods for the study of neurogenic erectile dysfunction.

Aged↗
PubMedDate not supplied

The care of patients with phantom limb pain in a pain clinic.

Patients referred to the Pain Clinic at the University of Virginia Medical Center with genuine phantom pain rather than stump pain have been treated by a variety of technics. Simple revision of drug therapy has proved helpful in some instances, as has repeated injection of trigger areas or neuromata, though surgical excision has proved necessary in some patients. Mechanical stimulation by stump tapping, prosthetic application, or electrical transcutaneous stimulation also may be useful. Sympathetic nerve block is occasionally very rewarding. Most patients need some form of psychological therapy. Rarely is cordotomy or higher central nervous system surgery required. There is no single best mode of therapy for phantom limb pain, nor can patients be guaranteed a permanent cure.

Autonomic Nerve Block↗