PubMed Health⌕ Search

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 163 records · Page 9Linked to original sources
PubMed1997

[Electrophysiologic and electrocardiographic aspects of the transplanted heart].

Specific electrophysiological properties of transplanted heart are caused mainly by complex surgery, suppression of autonomic innervation, and allograft rejection. Interpretation of ECG may be difficult because of two P waves. The other most prevalent ECG abnormalities are: incomplete or complete right bundle branch block, shift of QRS axis to the left, shorter QT interval, decreased precordial voltage. The influence of denervation is apparent in: higher basic heart rate, chronotropic dysfunction, different responsiveness to various cardiac drugs, susceptibility to fatal ventricular arrhythmias. The prevalence of bradyarrhythmias and tachyarrhythmias is higher than in other population. Many of them correlate with acute or chronic cardiac rejection. It is desirable to utilize specific electrophysiological properties for noninvasive detection of allograft rejection.

Arrhythmias, Cardiac↗
PubMed2005

Autonomic nervous system activity during autologous blood donation for orthognathic surgery.

PURPOSE: The aim of this study was to assess by means of power spectral analysis the immediate response of autonomic regulation that occurs with postural change from supine to sitting position (modified head-up tilt test [m-HUT]) during autologous blood donation (ABD) and postphlebotomy infusion. PATIENTS AND METHODS: We investigated 37 healthy adults who required preoperative ABD before elective orthognathic surgery. Measurements were conducted with m-HUT during ABD and postphlebotomy infusion. The data were analyzed using the maximum entropy method and the difference between supine and tilt was determined by analysis of variance. RESULTS: When m-HUT was conducted at the resting state, cardiac parasympathetic nervous activity was significantly decreased, whereas cardiac and vascular sympathetic nervous activities were significantly increased. When m-HUT was conducted following blood collection, cardiac parasympathetic nervous activity showed a tendency to increase, whereas vascular sympathetic nervous activity was significantly increased. These changes were not observed during postphlebotomy infusion. CONCLUSIONS: The m-HUT, which involves postural change from supine to sitting position, may be useful for observing autonomic nervous activity in the clinical setting. ABD carries the risk of imbalance of autonomic regulation. However, postphlebotomy infusion may reduce this imbalance.

Adult↗
PubMed1988

The autonomic nervous system and geriatric anesthesia.

Patients subjected to surgery and anesthesia must rely on autonomic mechanisms to maintain homeostasis and adequate organ perfusion. In the elderly, many of these mechanisms are limited in the strength, the rapidity, and the range in which they can compensate for physiological stresses and trespass. Anesthesiologists rely on predictable results from manipulation of the ANS and its effector organs, but aging in itself seems to alter the responses to these pharmacological manipulations. The diseases and medications that often accompany old age are further confounding factors. Some of the changes found with age seem to arise from the ANS itself, while some more likely originate in structural alterations of the cardiovascular system. Although both basic and clinical research reports are rife with contradictions, a knowledge of ANS aging should help us to anticipate the particular responses and requirements of our older patients.

Aged↗
PubMed1992

Percutaneous intranodular ethanol injection: a new treatment for autonomous thyroid adenoma.

Established methods for definitive ablation of autonomous thyroid nodules are surgery and radioiodine. Since it has been demonstrated that percutaneous ethanol injection can inactivate parathyroid adenomas and small hepatocellular carcinomas, we started a trial of this treatment in patients with autonomous thyroid nodules. Twenty-eight patients, 22 toxic and 6 nontoxic, all with undetectable thyrotropin serum levels and suppressed extranodular tissue on scintigraphy, were treated. Treatment consisted of percutaneous intranodular ethanol injection under ultrasound guidance. The total amount of alcohol injected ranged from 0.4 to 2.2 times the estimated nodule volume, divided into 4 to 9 injections performed at 2 to 7 day intervals. Most patients were treated with a single cycle of injections, but 7 of them required 2 cycles. The signs and symptoms of hyperthyroidism disappeared in all cases. Apparently complete cure (normal serum free thyroid hormones, thyrotropin in basal conditions and after thyrotropin releasing hormone, reactivation of extranodular tissue on scintigraphy with nodule no longer visible) was obtained in 17 patients (13 after 1 cycle and 4 after 2 cycles). Partial cure (normal serum free thyroid hormone levels, detectable thyrotropin levels with normal or blunted response to thyrotropin releasing hormone and partial reactivation of extranodular tissue on scintigraphy with nodule or parts of it still visible) was obtained in 10 patients (8 after 1 cycle and 2 after 2 cycles). In 1 patient with a very large nodule thyrotropin levels remained undetectable, but thyroid hormone levels eventually became normal. No recurrences were observed after a follow-up of 12 to 32 months (mean 20 months). No serious side effects were encountered. A clinically valuable result was obtained in all patients. These data suggest that this form of treatment could constitute an alternative to surgery and radioiodine for the ablation of autonomous thyroid nodules.

Adenoma↗
PubMed2003

Topography of the pelvic autonomic nervous system and its potential impact on surgical intervention in the pelvis.

Bladder, bowel, and sexual dysfunction caused by iatrogenic lesions of the inferior hypogastric plexus (IHP) are well known and commonly tolerated in pelvic surgery. Because the pelvic autonomic nerves are difficult to define and dissect in surgery, and their importance often ignored, we conducted a gross anatomic study of 90 adult and four fetal hemipelves. Using various non-surgical approaches, the anatomic relations and pathways of the IHP were dissected. The IHP extended from the sacrum to the genital organs at the level of the lower sacral vertebrae. It originated from three different sources: the hypogastric nerve, the sacral splanchnic nerves from the sacral sympathetic trunk (mostly the S2 ganglion), and the pelvic splanchnic nerves, which branched primarily from the third and fourth sacral ventral rami. These fibers converge to form a uniform nerve plate medial to the vascular layer and deep to the peritoneum. The posterior portion of the IHP supplied the rectum and the anterior portion of the urogenital organs; nerve fibers traveled directly from the IHP to the anterolateral wall of the rectum and to the inferolateral and posterolateral aspects of the urogenital organs. The autonomic supply from the IHP was supplemented by nerves accompanying the ureter and the arteries. An understanding of the location of the autonomic pelvic network, including important landmarks, should help prevent iatrogenic injury through the adoption of surgical techniques that reduce or prevent postoperative autonomic dysfunction.

Adult↗
PubMed1993

[Surgical therapy of the autonomous thyroid nodule].

Indications for the surgical removal of autonomous nodule are mainly based upon the failure of therapeutical options. The histological definition may be advantageous for detecting the rare but possible association between autonomous goiter and carcinoma of the thyroid. In personal experience, based on 176 hyperfunctioning goiter (among which there were 40 cases of autonomous nodules) 6 carcinomas of the gland were observed, 2 of these were associated with autonomous nodules. The extension of thyroidectomy is related to the size of the adenomas considering the incidence of postoperative complications, very low for this type of surgery. Surgical treatment of autonomous nodules of the thyroid is a low risk surgery and is therefore suitable for the treatment of this disease.

Adenoma↗
PubMed1996

Perioperative changes in cardiac autonomic control in patients receiving either general or local anesthesia for ophthalmic surgery.

To investigate whether local (LA) or general anesthesia (GA) provides more perioperative stability in cardiac autonomic tone, we analyzed heart rate variability (HRV) by means of spectral analysis, intraoperatively and up to 3 h postoperatively, in otherwise healthy patients scheduled for cataract surgery. Fourteen patients received GA (premedication: clorazepate; anesthetic induction: propofol, alfentanil, atracurium; anesthetic maintainance: isoflurane, alfentanil; airway management: laryngeal mask airway), and 14 patients received LA (retrobulbar block with bupivacaine/mepivacaine). In the GA group, total power, as an indicator of cardiac autonomic activity, was significantly reduced intraoperatively and increased slowly during the postoperative period. The ratio of low frequency/high frequency (LF/HF) power, indicating cardiac sympathovagal balance, did not change significantly intraoperatively and remained stable in the postoperative period. The LA group showed no significant changes in total power intraoperatively. Postoperatively, heart rate and the LF/HF power ratio were significantly increased in the LA group compared to the GA group. GA as described above was associated with intra- or postoperative stability of the cardiac sympathovagal balance. Thus GA had no disadvantageous effects on the perioperative cardiac autonomic tone during ophthalmic surgical procedures compared to LA in otherwise healthy patients.

Adult↗
PubMed2006

[Dose "extended" surgery for pancreatic head adenocarcinoma have survival impact?].

Adenocarcinoma of the pancreas is the most difficult to treat, and the prognosis, even if curative resection is possible, is dismal. Improving survival in this intractable disease is a challenging issue. Most Japanese surgeons have stressed that resection with extended lymphadenectomy and autonomic nerve dissection (extended surgery) can offer a better chance of long-term survival. On the other hand, surgeons in Western countries are skeptical about extended surgery and have preferred resection without extended lymphadenectomy (standard surgery). Two randomized controlled trials (RCTs) on "standard vs. extended surgery for pancreatic head adenocarcinoma" were reported in 1998 from Italy and in 2002 from USA. Those two RCTs demonstrated that extended surgery did not improve patient survival; however, they had little impact on Japanese surgeons because the extended surgery used in those RCTs were not "true" extended surgery. Thereafter, one RCT was conducted in Japan in which extensive lymphadenectomy including paraaortic node and complete resection of autonomic nerves around the common hepatic and the superior mesenteric arteries were performed in extended surgery. Unexpectedly, the results showed that the survival rates were similar between extended and standard surgeries, compatible with the results of the Western RCTs. We should therefore conclude that extended surgery does not improve survival for patients with pancreas head adenocarcinoma.

Adenocarcinoma↗
PubMed2005

The autonomic nervous system of the human heart with special reference to its origin, course, and peripheral distribution.

A submacroscopic anatomical investigation of the entire autonomic cardiac nervous system, from origin to peripheral distribution, was performed by examining 36 sides of 18 adult human cadavers under a stereomicroscope. The following new results and points of discussion were obtained: (1) The superior cervical, the middle cervical, the vertebral, and the cervicothoracic (stellate) ganglia, composed of the inferior cervical and 1st thoracic ganglia, were mostly consistent among the specimens. (2) The superior, middle, and inferior cardiac nerves innervated the heart by simply following the descent of the great arteries. In contrast, the thoracic cardiac nerve in the posterior mediastinum followed a complex course because of the long distance to the middle mediastinum. (3) The actual course of the right thoracic cardiac nerve differed from that of the previous descriptions in that it ascended obliquely or ran transversely to the vertebrae, regardless of the intercostal vessels. Regarding the right thoracic cardiac nerve, two descending courses were observed: the descent of the right thoracic cardiac nerve via the azygos vein and right venous porta, and the descent of the recurrent right thoracic cardiac nerve via the aorta. (4) The cranial cardiac nerve and branch tended to distribute into the heart medially, and the caudal cardiac nerve and branch tended to distribute into the heart laterally. (5) The mixing positions (cardiac plexus) of the sympathetic cardiac nerve and the vagal cardiac branch, as well as the definitive morphology of brachial arteries with the recurrent laryngeal nerves, tended to differ on both sides. These new and detailed anatomical descriptions of the human autonomic cardiac nervous system may provide important clues regarding the morphogenesis of autonomic cardiac nerves in addition to contributing to the improvement of cardiac surgery.

Autonomic Nervous System↗
PubMed2004

Minimal-access surgery training in the Netherlands: a survey among residents-in-training for general surgery.

BACKGROUND: The purpose of this study was to assess the state of surgical training and its possible shortcomings in minimal-access surgery (MAS) among Dutch surgical residents. METHODS: A pretested questionnaire was distributed to all residents-in-training for general surgery in The Netherlands. RESULTS: The questionnaire was sent to 407 surgical residents. The response rate was 65%. Overall, 87.7% of all the responders were highly interested in the autonomous performance of laparoscopic surgery. Residents interested in gastrointestinal (GI) or oncologic surgery (n = 137) are significantly more interested than residents interested in non-GI/oncologic surgery. All the residents (100%) thought it was important to be able to perform the three basic MAS procedures (diagnostic laparoscopy, laparoscopic cholecystectomy, and laparoscopic appendectomy) autonomously at the end of their surgical training. Other MAS procedures were considered to be advanced procedures. Gastrointestinal/oncologic residents were most interested in performing advanced MAS procedures, although only 17.8% expected to be adequately prepared at the end of their surgical training. Most residents had the opportunity to attend MAS skills education. Irrespective of the format or training method, only 26.9% of residents stated their MAS skills training was objectively evaluated. The residents thought every surgical hospital department in the Netherlands should have a surgeon specialized in laparoscopic surgery (86.9%). CONCLUSIONS: The current study showed that Dutch residents believe it is very important to perform basic MAS autonomously. Of the GI/oncologic-interested residents, the majority want to be able to perform advanced MAS, but expect to be unable to do so at the end of their training. They attribute this discrepancy to "not having enough chance to be the first operator" and to "lack of volume of procedures in the hospital." Specific and properly implemented, monitored, and evaluated MAS skills training programs in skills laboratory settings could offer a promising environment for overcoming this discrepancy.

Adult↗
PubMed1997

Efficacy of low doses of radioiodine in the treatment of autonomous thyroid nodules: importance of dose/area ratio.

Radioiodine (131I) represents an interesting alternative to surgery in the treatment of autonomously functioning thyroid nodules (AFTN), but leads to a significant incidence of hypothyroidism when high doses are used. Over 4 years, we have treated 40 patients (hyperthyroid [Plummer's disease]: 6, single hot nodules with undetectable thyrotropin [TSH] and normal serum free thyroxine [FT4]: 34), 34 single hot nodules with undetectable thyrotropin TSH and normal serum free thyroxine [FT4] with 131I. The dose level was neither related to the concentration of FT4 nor to the iodine uptake on thyroid scintigram. Retrospectively we measured the nodule's area on the scan and calculated the dose/area ratio (DAR). Three months after treatment, 30 patients were euthyroid, 9 were still hyperthyroid, and 1 was hypothyroid. The mean DAR of the euthyroid patients was twofold higher than for the hyperthyroid subjects (1.4 +/- 0.8 vs. 0.7 +/- 0.3 mCi/cm2; p = .003) and one-half the DAR for the hypothyroid patient (2.82 mCi/cm2). Twenty of the 30 euthyroid patients had received a dose higher than 1 mCi/cm2 and 7 of 9 hyperthyroid patients had received a dose lower than 1 mCi/cm2. (chi2 = 12.9; p = .02). The initial values of T4, TSH, and dose level of patients who were euthyroid or hyperthyroid at 3 months were not different. These data suggest that the efficacy of 131I for treating AFTN depends on the DAR, rather than the initial T4 value or the 131I uptake. A DAR between 1 and 1.5 mCi/cm2 seems to be optimal and avoids hypothyroidism.

Aged↗