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At least 1,279 records · Page 71Linked to original sources
PubMed1999

Lumbar sympathectomy as isolated technique for the treatment of lower limbs chronic ischemia.

BACKGROUND: Lumbar sympathectomy (LS) is often the only alternative treatment that can be considered as a means of improving the distal circulation to such extent that major amputation is prevented. To make a retrospective study in order to know the current value of LS as isolated technique for the treatment of severe ischemia of lower limbs in the absence of the possibility for vascular reconstruction. METHODS: Between 1987 and 1992, 100 LS were performed in 93 patients (82 males and 11 females) aged 64.5+/-11.1 yrs. 63% were older than 70 years. Indication was invalidant claudication/rest pain (grade II, 57%) or trophic lesion (grade III, 43%) in patients where previous reconstructive surgery failed (18%), was not possible to do (23%) or refused revascularization (20%), or with poor surgical risk (39%). Preoperative evaluation included Doppler measures, ankle/brachial index (ABI) and arteriography in every case. Surgical sympathectomy was performed in all patients. Success was considered if rest pain was absent or trophic lesions have healed at six months, comparing results in patients diabetics and non-diabetics with ABI higher or lower 0.3. RESULTS: Postoperative stage was 6.4+/-2.3 days. Morbidity was 4% and mortality was 7% in the 30-day postoperative period, related with patients older than 70 years. Long-term mortality was 9%, for a global nortality of 16%. 12 patients needed inflow surgery after LS. There was success in 58.5% of grade II and 61.7% of grade III patients at six months, with significative difference (p=0.049) if ABI was >0.3. In diabetics with ABI >0.3, trophic lesions have worse prognostic than ABI <0.3. Pre- and postoperative ABI were correlated (R2=0.65), and the increasing of 0.1 in preoperative ABI had a positive prognostic value over lesion healing. Patency of superficial femoral artery (SFA) has correlated significantly (p=0.000021) with successful outcome after LS. CONCLUSIONS: LS could be a technique that moderately improves the ischemic limb in patients who refuse major surgery or where arterial reconstruction is not indicated. Preoperative ABI has prognostic value in postoperative outcome, with clinical improvement if it is >0.3. Diabetes has not been a negative predictive factor in our series. Patency of superficial femoral artery is related to successful outcome of the patients.

Adult↗
PubMed1999

Sacral nerve stimulation for treatment of refractory urinary urge incontinence. Sacral Nerve Stimulation Study Group.

PURPOSE: A prospective, randomized study was performed to evaluate sacral nerve stimulation for the treatment of refractory urinary urge incontinence. MATERIALS AND METHODS: Primary outcome variables were obtained from voiding diaries. After baseline evaluation candidates who satisfied inclusion criteria were enrolled into the study. Test stimulation results determined eligibility for randomization into a stimulation (treatment) or delay (control) group. The stimulation group included 34 patients who underwent implantation and were followed for 6 months. The delay group comprised 42 patients who received standard medical therapy for 6 months and then were offered implantation. The stimulation group completed a therapy evaluation test (on versus off) after 6 months. RESULTS: At 6 months the number of daily incontinence episodes, severity of episodes and absorbent pads or diapers replaced daily due to incontinence were significantly reduced in the stimulation compared to the delay group (all p<0.0001). Of the 34 stimulation group patients 16 (47%) were completely dry and an additional 10 (29%) demonstrated a greater than 50% reduction in incontinence episodes 6 months after implantation. Efficacy appeared to be sustained for 18 months. During the therapy evaluation test the group returned to baseline levels of incontinence when stimulation was inactivated. Urodynamic testing confirmed that sacral nerve stimulation did not adversely affect voiding function. Complications included implantable pulse generator site pain in 15.9% of the patients, implant site pain in 19.1% and lead migration in 7.0%. Surgical revision was required in 32.5% of patients with implants to resolve a complication. There were no reports of permanent injury or nerve damage. CONCLUSIONS: Sacral nerve stimulation is safe and effective in treating refractory urinary urge incontinence.

Adult↗
PubMed1999

Lumbar epidural sympathectomy for frostbite injuries of the feet.

Fourteen patients with pain and paresthesias secondary to frostbite injury were treated with lumbar sympathetic blockade. The majority of patients had an excellent response to 48 hours of continuous epidural blockade with no recurrence of symptoms after blockade. Those patients who had a limited response to epidural blockade responded well to surgical lumbar sympathectomy. Lumbar sympathetic blockade is a safe and effective technique for treating the symptoms associated with frostbite injury.

Adult↗
PubMed2000

Influence of sacral neuromodulation on electrosensation of the lower urinary tract.

PURPOSE: We prospectively investigated whether neuromodulation of the S3 root influences the sensory threshold to electrical stimulation in the lower urinary tract. MATERIALS AND METHODS: The study included 7 women and 3 men receiving S3 neuromodulation at 210 msec. and 25 Hz. with the Interstim PNE system for a mean of 5 days. Neuromodulation was done unilaterally in 6 cases and bilaterally in 4. The sensory threshold was determined by electrodes placed randomly against the mucosa of the empty bladder on the left and right sides, in the urethra in women, and in the prostatic and penile urethra in men. Thresholds were measured at each location with neuromodulation on and off. RESULTS: With bilateral neuromodulation on all 4 patients had a lower bladder threshold than with neuromodulation off. In unilateral neuromodulation the threshold was significantly lower during neurostimulation on the ipsilateral side. There was no effect on the threshold on the arm or in the urethra. The effect was noted in patients in whom neuromodulation was and was not clinically successful. CONCLUSIONS: Neuromodulation on S3 influences the nervous system involved in electrosensation of the bladder but not the skin afferent innervation or the nerves involved in urethral electrosensation. These data support the hypothesis that S3 neurostimulation is effective mainly through the afferent nervous system in the pelvic nerves.

Adult↗
PubMed1999

Sacroiliac joint innervation and pain.

The present paper reviews current knowledge on the innervation of the human sacroiliac joint (SIJ). We conclude, based on a recent anatomic study on adult cadavers, with fetal correlation, that the joint is predominantly, if not entirely, innervated by sacral dorsal rami. This conclusion is in agreement with patterns of referred pain reported by asymptomatic volunteers upon direct SIJ capsular stimulation and with a reduction in pain in patients treated for (presumptive) SIJ pain by injection of an anesthetic into the SIJ. We also present preliminary data suggesting that the periarticular tissues of the SIJ, like those of other synovial joints, contain mechanoreceptors and nociceptors that function to inform the central nervous system about the state of the joint.

Adult↗
PubMed1999

[Sympathectomy and intra-arterial perfusion therapy in critical ischemia of the lower limbs].

The results of 177 sympathectomies fulfilled in 152 patients with critical ischemia of the lower extremities are presented. Good and satisfactory results were obtained in 69.3% of patients after lumbar sympathectomy only. When the operation was combined with prolonged intraarterial catheter therapy positive effects were noted in 79.7% of the cases. This combined method of treatment is thought to be expedient for patients with the IV degree ischemia.

Adolescent↗
PubMed1999

[Minimal invasive lumbar sympathectomy].

Forty-four lumbar sympathectomies have been made on 42 patients by ROMICRO-set at the authors' department. This method--made by a specially developed lighting retractor system--ensures the same exposure as the traditional approach, but the visibility of the operative field is much better. The costs of the material character are low. Technique of the operation is discussed. Authors have got good experiences: there were no complications, postoperative pain is minimal, the time of the hospitalization is shortened. A special advantage of this new approach is that it can be even made on patients-belonging to ASA IV., and they can be operated on in epidural anesthesia. The authors recommend this new method only for those surgeons who are experienced in the technique of traditional lumbar sympathectomies.

Humans↗
PubMed2000

Sacral nerve neuromodulation in the treatment of patients with refractory motor urge incontinence: long-term results of a prospective longitudinal study.

PURPOSE: Conservative treatment rarely results in a durable cure of patients with urge incontinence and bladder overactivity. Instrumental and surgical procedures often have significant side effects and less than optimal results. We developed a technique of sacral nerve neuromodulation using chronic unilateral electrical stimulation of the S3 sacral nerve to inhibit the micturition reflex to provide effective nondestructive alternative therapy for patients whose condition is refractory to conservative treatment. MATERIALS AND METHODS: Of 85 patients 45 who responded to a test with a temporary electrode underwent implantation of a permanent S3 sacral nerve electrode coupled to a pulse generator. Treatment results were evaluated by urodynamic studies and voiding/incontinence diaries documenting pad use, incontinence episodes, voiding frequency and voided volume. Partial success and cure were defined as 50% to 90% and more than 90% improvement, respectively, in pad use and/or incontinence episodes. RESULTS: Of 45 patients 18 (40%) were cured at an average followup of 47.1 months and 9 (20%) achieved partial success. Median number of pads used and median number of incontinence episodes daily had decreased from 5.4 to 1.2 (p = 0.0001) and 7.1 to 1.3 (p = 0.0001), respectively, 6 months after implantation. Subsequently these results remained almost constant for 5 years. Bladder overactivity disappeared in 19 of the 44 patients (43%). The repeat intervention rate was 37.7% and there was no permanent injury or nerve damage. CONCLUSIONS: Sacral nerve neuromodulation is safe, effective and durable in patients with urge incontinence refractory to conservative treatment.

Adolescent↗
PubMedDate not supplied

[The anatomico-surgical aspects of the lumbar sympathetic network].

Our article yields new statements about macroscopic anatomy of the sympathetic lumbar chain, after the dissection of 480 corpses in a 15 years period. Our observations state new conclusions, with implications in surgical practice, about the function and the vegetative territory of the lumbar sympathetic chain.

Afferent Pathways↗
PubMed2000

An intracellular study of pudendal afferent inputs onto tail motoneurons in the spinalized cat.

Postsynaptic potentials, elicited by stimulation of the sensory pudendal (SPud) and superficial perineal nerves (SPeri) on both sides, were recorded from motoneurons innervating tail muscles in the non-anaesthetized and spinalized cat. The stimulation of SPud and SPeri on both sides predominantly produced excitatory postsynaptic potentials (EPSPs) in all kinds of tail motoneurons (70-95%). The inhibitory postsynaptic potentials (IPSPs) were often observed in motoneurons innervating ventral tail muscles (30-33%). The means of averaged central latencies of EPSPs and IPSPs ranged from 4.3 to 7.3 ms, and from 4.6 to 8.4 ms, respectively. The findings suggests that polysynaptic neuronal pathways from pudendal nerve to tail motoneurons produce tonic activities of all tail muscles to raise the tail in micturation, defecation and sexual movements which are induced by stimulation of pudendal nerves.

Animals↗