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PubMed1995

Neural arch tuberculosis: a morbid disease. Radiographic and computed tomographic findings.

We have reviewed the clinical features, together with the radiographs and computerised tomography, in 9 patients with tuberculosis of the vertebral body and neural arch. All presented with paraparesis or paraplegia. The morbidity associated with this disease is so serious that it is essential to have an accurate means of evaluating the lesion as early as possible. Routine radiographs can only indicate the level of the disease and the loss of disc space, but cannot define the full extent of the lesion. Computed tomography shows details of the tuberculous involvement of the neural arch, as well as the vertebral body and spinal canal; the site and extent of the soft tissue lesions can also be seen. This is essential for evaluation of the neural arch involvement which will enable the clinician to select the appropriate treatment, and so prevent neurological complications.

Adult↗
PubMed1991

The vasopressin-like immunoreactive (VPLI) neurons of the locust, Locusta migratoria. I. Anatomy.

Antiserum to arginine-vasopressin has been used to characterise the pair of vasopressin-like immunoreactive (VPLI) neurons in the locust. These neurons have cell bodies in the suboesophageal ganglion, each with a bifurcating dorsal lateral axon which gives rise to predominantly dorsal neuropilar branching in every ganglion of the ventral nerve cord. There are extensive beaded fibre plexuses in most peripheral nerves of thoracic and abdominal ganglia, but in the brain, the peripheral plexuses are reduced while neuropilar branching is more extensive, although it generally remains superficial. An array of fibres runs centripetally through the lamina-medulla chiasma in the optic lobes. Lucifer Yellow or cobalt intracellular staining of single VPLI cells in the adult suboesophageal ganglion shows that all immunoreactive processes emanate from these two neurons, but an additional midline arborisation (that was only partially revealed by immunostaining) was also observed. Intracellularly staining VPLI cells in smaller larval instars, which permits dye to reach the thoracic ganglia, confirms that there is no similar region of poorly-immunoreactive midline arborisation in these ganglia. It has been previously suggested that the immunoreactive superficial fibres and peripheral plexuses in ventral cord ganglia serve a neurohaemal function, releasing the locust vasopressin-like diuretic hormone, F2. We suggest that the other major region of VPLI arborisation, the poorly immunoreactive midline fibres in the suboesophageal ganglion, could be a region where VPLI cells receive synaptic input. The function of the centripetal array of fibres within the optic lobe is still unclear.

Animals↗
PubMed1988

Immunohistological demonstration of a substance related to neuropeptide Y and FMRFamide in the cephalic and thoracic nervous systems of the locust Locusta migratoria.

A neuropeptide related to the mammalian neuropeptide Y (NPY) is present in various neurosecretory cells (NSC) of the cephalic and thoracic nervous systems of the insect Locusta migratoria. Immunoreactive perikarya are detected in the protocerebrum, tritocerebrum, optic lobes and the suboesophageal and thoracic ganglia. They give rise to many immunoreactive processes that ramify extensively throughout the neuropiles. In the brain, prominent axon bundles tightly surround the tractus I to the corpora cardiaca. This fiber pattern suggests that the NPY-like substance may have a neuromodulator and/or neurotransmitter function. This substance may also have a neurohormonal role, since some immunoreactive tracts penetrate into neurohaemal organs via the nervi corporis cardiaci II and the thoracic median nerves. NCS containing NPY-like neuropeptide also display an FMRFamide-like immunoreactivity (except for the abdominal part of the metathoracic ganglion). NPY or FMRFamide antisera are not inactivated after preabsorption with FMRFamide or NPY, respectively. It might therefore be inferred that in locust NSC these two antisera recognize two distinct antigenic sites belonging either to a large polypeptide, or to two distinct neuropeptides.

Amino Acid Sequence↗
PubMed1988

The development of GABA-like immunoreactivity in the thoracic ganglia of the locust Schistocerca gregaria.

The development of GABA-like immunoreactivity was investigated in embryonic and juvenile locusts using an antibody raised against GABA-protein conjugates. GABA-like immunoreactivity was first detectable in the neuropile of embryonic ganglia at 55% development, and in neuronal somata at 62% development. The total number of immunoreactive somata increased between 62% and 85% embryonic development, and followed an anterio-posterior pattern of expression. At 85% development, the number of immunoreactive somata reached adult levels and no change in number was then seen. In embryonic stages and first and second juvenile instars two dorsal and four ventral groups of somata were labeled in all three thoracic ganglia, whilst in later juvenile instars one of the dorsal groups was visible as a separate entity only in the metathoracic ganglion. These early patterns were modified by alterations in the positions of some of the groups during late embryogenesis and during juvenile development to produce the adult pattern. The results show that the development of GABA expression is similar to that of other neurotransmitters. The characteristics of the development of immunoreactivity indicate that some of these immunoreactive clusters may be derived from clonally related neurones. Finally, we demonstrate the presence of immunoreactive somata and processes in embryos, which correspond to those of identified local and intersegmental interneurones studied in the adult.

Aging↗
PubMed1980

Callosal projections from the two body midlines.

1. Horseradish peroxidase (HRP) was injected within the proximal limb and trunk representation zones of the first somatosensory area (SI) of 16 cats. The tangential and laminar distributions of retrogradely labelled neurones (callosal neurones) of the contralateral homotopic cortex were studied. This cortex was explored with microelectrodes on the day after HRP delivery to relate the distribution of callosal neurones to the electrophysiological map of the trunk. 2. Callosal neurones were found in the contralateral SI area mainly in layer III, but also many in layer VI, especially following large HRP injections, and very few in the other layers. Callosal neurones of layer III were mostly pyramidal, those of layer VI pyramidal and non-pyramidal. Many neurones were intensely stained by HRP, and cell details, such as fine dendritic branchings, spines, and axon collaterals, could be seen. 3. Callosal neurones are grouped within two regions located, respectively, in the rostral and caudal parts of the exteroceptive trunk map. The rostral region overlaps the representation of the dorsal midline (cytoarchitectonic field 3b) and the second one that of the ventral body midline (cytoarchitectonic field 2). The cortex intermediate between these two fields contains rare callosal cells and receives afferences from the lateral trunk surface. Few or no callosal cells were found within the proximal limb zones. Neurones recorded from the two midline zones have bilateral receptive fields straddling either the back or the ventral surface of the trunk. 4. It is concluded that the interhemispheric fusion between the two hemibody representations in areas SI is brought about by the mutual callosal links which the two midline zones entertain with their contralateral homologues.

Animals↗
PubMed1995

Thoracoscopic sympathectomy for Buerger's disease: a report on the successful treatment of four patients.

We describe herein the successful treatment of four patients with ischemic ulcers or gangrene of the fingers due to Buerger's disease by thoracoscopic sympathectomy, a new method of surgery which eliminates the difficulties associated with the traditional "open" approaches to the thoracic sympathetic chain, such as poor exposure, risk of damage to the adjacent structures, and postoperative pain. After the patients were placed in the lateral decubitus position with unilateral pulmonary ventilation, the thoracic sympathetic ganglia (T) from the lower third of T1 to T3 were resected endoscopically. The operative results were excellent, with improvement or complete resolution of the ulcer being achieved in all four patients. All of the patients were satisfied with the results in terms of ulcer healing, postoperative pain, and cosmetic appearance. Although a postoperative air leakage developed in one patient with a history of pulmonary tuberculosis, it was successfully treated with an adhesive agent. None of the patients developed Horner's syndrome. Thus, because thoracoscopic sympathectomy is easier to perform with a lower risk of complications than conventional thoracic sympathectomy, we recommend this operative approach as the procedure of choice for surgical thoracic sympathectomy.

Fingers↗
PubMed1988

Effects of upper dorsal sympathectomy on esophageal motility in humans.

To evaluate the role of the sympathetic nervous system in modulating esophageal motility, esophageal manometry was performed on two groups of patients who underwent upper dorsal sympathectomy for relief of palmar hyperhydrosis. In six patients sympathectomy was done by the supraclavicular approach, with removal of T2 and T3 ganglia. Manometry was performed before the operation and three weeks after it. In seven other patients sympathectomy was done by the axillary approach, with removal of T2-T4 ganglia. Manometry in this group was performed 28.4 +/- 22.4 months after the operation. Fifteen individuals with an intact sympathetic system served as controls. Manometric parameters evaluated were esophageal contraction amplitude and duration and lower esophageal sphincter pressure. The difference between the results obtained in the pre- and postoperative periods in the first group was not statistically significant. The differences between the two patient groups and between the patient groups and the control group were not statistically significant either. We conclude that upper dorsal sympathectomy does not affect esophageal motility in man.

Adolescent↗
PubMed1987

Anatomical basis of modern thoracotomies: the latissimus dorsi and the "serratus anterior-rhomboid" complex.

The latissimus dorsi and the "serrato-rhomboid" complex are the muscles most often involved in present-day thoracotomies for lung surgery. The present anatomic study emphasizes: the continuity between the serratus anterior and the rhomboid levator scapulae mass as a wide muscular sheet with a deep common fascia, extending the serrato-thoracic space (of Gillis) to the vertebral column as the rhomboserrato-thoracic space (the levator scapulae is situated higher up, above the ordinary thoracotomy); the presence of a "composite fascia" in the posterior angle between the seratus anterior and the rhomboid; the long costal attachment area and the presence of two differently oriented layers for the muscular digitations of the middle and inferior parts of the serratus anterior. With a rich vascular supply from multiple sources, the serratus anterior and latissimus dorsi are two large flat muscles with a single longitudinal nervous pedicle proceeding from the brachial plexus. To avoid esthetic (winged scapula) and functional sequelae, it is imperative to safeguard this single innervation as far as possible : by halting division of the serratus anterior before reaching its neurovascular pedicle in lateral or anterolateral thoracotomy, and by transecting the latissimus dorsi very low down in standard postero-lateral thoracotomy. The other muscles are simply freed and retracted.

Humans↗
PubMed1994

Vagal control of transpyloric flow and pyloric resistance.

Vagal control of pyloric resistance was evaluated in anesthetised pigs by recording gastropyloroduodenal motility and transpyloric flow during emptying of a liquid nonnutrient meal. Vagotomy did not modify pyloric resistance or the characteristics of the flow pulses. Electrical stimulation of the distal stumps of cervical or thoracic vagus nerves decreased pyloric resistance and triggered flow pulses of large stroke volume. This was associated with increased fundic tone and pressurization of the antrum. Phentolamine but not propranolol reduced the responses to vagal stimulation. These observations demonstrate that reduced pyloric resistance is one mechanism by which vagal activation promotes transpyloric flow.

Animals↗
PubMed2001

Influence of thoracic sympathectomy on cardiac induced oscillations in tissue blood volume.

The photoplethysmographic (PPG) signal, which measures cardiac-induced changes in tissue blood volume by light transmission measurements, shows spontaneous fluctuations. In this study, PPG was simultaneously measured in the right and left index fingers of 16 patients undergoing thoracic sympathectomy, and, from each PPG pulse, the amplitude of the pulse (AM) and its maximum (BL) were determined. The parameter AM/BL is proportional to the cardiac-induced blood volume increase, which depends on the arterial wall compliance. AM/BL increased after the thoracic sympathectomy treatment (for male patients, from 2.60+/-1.49% to 4.81+/-1.21%), as sympathetic denervation decreases arterial tonus in skin. The very low-frequency (VLF) fluctuations of BL or AM showed high correlation (0.90+/-0.11 and 0.92+/-0.07, respectively) between the right and left hands before the thoracic sympathectomy, and a significant decrease in the right-left correlation coefficient (to 0.54+/-0.22 and 0.76+/-0.20, respectively) after the operation. The standard deviation of the BL or AM VLF fluctuations also reduced after the treatment, indicating sympathetic mediation of the VLF PPG fluctuations. The study also shows that the analysis of the PPG signal and the VLF fluctuations of the PPG parameters enable the assessment of the change in sympathetic nervous system activity after thoracic sympathectomy.

Adolescent↗
PubMedDate not supplied

Diabetic truncal mononeuropathy: electromyographic evaluation.

Fifteen diabetic subjects wih thoracic radiculopathy were studied wih paraspinal electromyography. The majority were elderly, mature onset diabetics presenting with unilateral hyperesthesia in a thoracic radicular pattern. None was under adequate control at onset, but control did not seem to alter the symptoms. Electromyography demonstrated localized paraspinal positive waves at the appropriate clinical level. Although not all subjects presented wih peripheral neuropathy, the majority showed electromyographic alteration. This should be an important adjunct in evaluation of diabetic patients with truncal mononeuropathy.

Adult↗
PubMed1990

Cerebrospinal norepinephrine concentrations and the duration of epidural analgesia.

This study was performed to determine whether the addition of norepinephrine to local anaesthetics prolongs epidural analgesia in man. In addition, cerebrospinal fluid norepinephrine (NE) concentrations were measured. In the first part of the study, epidural catheters were inserted in 14 patients before herniotomy. Mepivacaine, 1.5 per cent (0.35 ml.kg-1), was administered and norepinephrine (5 micrograms.ml-1) was added in seven patients. The duration of anaesthesia was prolonged from 54 +/- 11 min to 83 +/- 12 min (P less than 0.05) and CSF NE concentrations increased from 68 +/- 12 pg.ml-1 to 336 +/- 85 pg.ml-1 in the NE group (P less than 0.01). In the second part, eight patients with herpetic neuralgia received epidural analgesia at the fourth to eighth thoracic interspace, using bupivacaine 0.25 per cent, with and without NE. The CSF NE concentrations in this group were greater than in the surgical patients before operation and increased from 254 +/- 58 to 406 +/- 58 pg.ml-1 30 min after administration of bupivacaine with NE. The duration of pain relief was prolonged with NE. These results suggest that adding NE to local anaesthetics prolongs epidural analgesia. Moreover, NE concentrations in surgical patients increased to levels similar to those found in patients suffering from herpetic analgesia. This suggests that the increase of CSF NE in chronic pain states has an antinociceptive effect.

Analgesia, Epidural↗
PubMed2006

Bilateral pain relief after unilateral thoracic percutaneous sympathectomy.

PURPOSE: To present a case of unexpected bilateral pain relief following unilateral thoracic percutaneous sympathectomy. CLINICAL FINDINGS: We present a case report where severe ischemic pain due to paraneoplastic Raynaud's syndrome with distal gangrene was successfully treated by means of percutaneous thoracic sympathectomy. A unilateral T2, T3 radiofrequency sympathectomy combined with small volume phenol injection resulted in unexpected bilateral pain relief. CONCLUSION: Our observations from this case report suggest a possible crossover of sympathetic innervation at the cervical and thoracic levels. Percutanenous thoracic radiofrequency sympathectomy is a feasible option for the treatment of refractory ischemic upper limb pain.

Aged↗