RESUMO
Greater splanchnic nerves (GSNs) and lesser splanchnic nerves (LSNs) are the dominant nerves in the pain of advanced cancer patients, which provides the base of retroperitoneal laparoscopic splanchnicectomy. We dissected 25 cadavers to provide anatomic basis for the surgery. Most GSNs entered the abdominal cavity close to the medial crus of the diaphragm while most LSNs the middle one. The number of the branch varies from 1 (which was 80 %) 3. The abdominal segment length of LSNs and GSNs was 26 mm and 20 mm respectively. The mean diameter of the nerves was about 2 mm. The laparoscope was put through abdominal wall beneath the 12th rib at the posterior axillary line, best angles and distances for the surgery were 50 ° and 80-110 mm respectively. The anatomic parameters of splanchnic nerves in the abdominal cavity as well as the angle and distance for the retroperitoneal laparoscopic splanchnicectomy and the anatomic landmarks were presented by the study. Besides the advantages of small incision, less pain and quick recovery, the anatomic parameters provided a practicable approach for the retroperitoneal laparoscopic splanchnicectomy.
Los nervios esplácnicos mayores (NEM) y los nervios esplácnicos menores (NEm) son los nervios dominantes en el dolor de los pacientes con cáncer avanzado, que proporciona la base de la esplacnicectomía laparoscópica retroperitoneal. Se disecaron 25 cadáveres para proporcionar base anatómica para la cirugía. La mayoría de los NEM entraron en la cavidad abdominal cerca del pilar medial del diafragma, mientras que la mayoría de los Nem lo hicieron cerca del pilar medio. El número de ramas varía de 1 (que era del 80 %) - 3. La longitud del segmento abdominal de NEm y NEM fue de 26 mm y 20 mm, respectivamente. El diámetro medio de los nervios era de aproximadamente 2 mm. El laparoscopio se colocó a través de la pared abdominal debajo de la 12 costilla en la línea axilar posterior, los mejores ángulos y distancias para la cirugía fueron de 50° y 80-110 mm, respectivamente. Los parámetros anatómicos de los nervios esplácnicos en la cavidad abdominal, así como el ángulo y la distancia para la esplacnicectomía laparoscópica retroperitoneal y los puntos de referencia anatómicos fueron presentados por el estudio. Además de las ventajas de la incisión pequeña, menos dolor y recuperación rápida, los parámetros anatómicos proporcionaron un enfoque práctico para la esplacnicectomía laparoscópica retroperitoneal.
Assuntos
Humanos , Nervos Esplâncnicos/anatomia & histologia , Nervos Esplâncnicos/cirurgia , Laparoscopia/métodos , Espaço Retroperitoneal , CadáverRESUMO
STUDY OBJECTIVE: To demonstrate the technique of laparoscopic dissection for identification of sacral nerve roots and pelvic splanchnic nerves. DESIGN: Case report (Canadian Task Force classification III). SETTING: Private practice hospital in São Paulo, Brazil. PATIENT: A 31-year-old woman with suspected iatrogenic and/or compression of sacral nerve roots. She reported debilitating pelvic, gluteal, and perineal unilateral left-sided pain (score 8 on a pain scale of 0-10), and had primary infertility with 1 previous failed attempt at in vitro fertilization. Surgical history included laparoscopic excision of endometriosis 10 months before the procedure and left oophoroplasty during adolescence because of a benign neoplasm. INTERVENTIONS: Standard 4-puncture laparoscopy was performed. The peritoneum of the left pelvic sidewall was resected to preclude eventual residual endometriosis. This also enabled identification of uterine vessels including the deep uterine vein, which is the limit between the pars vascularis superiorly and the pars nervosa inferiorly in the uterine broad ligament. Surgery was using the laparoscopic neuro-navigation (LANN) technique, previously described by one of us (M. P.). For identification of the sacral roots, dissection was begun medial to the ureter and lateral to the uterosacral ligament. The Okabayashi pararectal space was entered as deep as possible via blunt dissection in avascular spaces. Hemostasis was performed using 5-mm bipolar forceps, and harmonic energy was not used. The hypogastric fascia was entered from medial to lateral, and the piriformis muscle was identified. The sacral nerve root S1 was identified lying over it. Dissection then proceeded caudally, and sacral roots S2 and S3 were sequentially identified. Small and delicate fibers forming the pelvic splanchnic nerves were isolated emerging from sacral roots S2 and S3. Other nerve fibers were identified caudally, probably representing pelvic splanchnic nerves emerging from S4. MEASUREMENTS AND MAIN RESULTS: The surgical operative time was 70 minutes, and bleeding was minimal. No suspected compression or iatrogenic injury was identified. The patient was discharged on the day after the procedure. At 8-month follow-up, she had partial resolution of pain (score 5, pain scale 0-10), and another failed attempt at in vitro fertilization was attributed to unsatisfactory quality of the embryos. There were no symptoms or dysfunctions attributable to manipulation of the nerves. CONCLUSION: Laparoscopy is a useful tool for identification of sacral roots and pelvic splanchnic nerves in suspected diseases. Its application in the field of neuropelveology can be expanded with proper knowledge and training.
Assuntos
Laparoscopia/métodos , Síndromes de Compressão Nervosa/cirurgia , Dor Pélvica/cirurgia , Raízes Nervosas Espinhais/cirurgia , Nervos Esplâncnicos/cirurgia , Adolescente , Adulto , Brasil , Ligamento Largo/cirurgia , Dissecação , Endometriose/cirurgia , Feminino , Humanos , Dor Pélvica/etiologia , Pelve/cirurgia , SacroRESUMO
Resting plasma epinephrine (E) and norepinephrine (N) concentrations for intact toads (Bufo paracnemis) were 5.57+/-1.0 and 0.88+/-0.38 ng/ml, respectively. Exercise induced a significant increase in heart rate, blood pressure and plasma epinephrine (about 4.3 times), whereas norepinephrine remained unchanged. The resting [E]/[N] ratio was 6.3 and increased to 32.9 during exercise. Adrenal denervation did not alter the basal plasma catecholamine or norepinephrine levels after exercise, but prevented the increase in epinephrine during exercise, suggesting that in the intact toad this increase is due to adrenal secretion whereas resting norepinephrine may be liberated by extra-adrenal chromaffin tissues. This also suggests that the adrenal glands can release selectively the two catecholamines. The increases in heart rate and blood pressure in denervated toads were not significantly different from those of intact animals, suggesting that during exercise the sympathetic nerves play the main role in inducing cardiovascular responses. Spinal transection induced a significant increase in basal norepinephrine levels, which remained elevated after exercise. Since spinal toads are unable to perform spontaneous movements it is possible that this increase may be caused by this stressful condition. The increases in heart rate and blood pressure observed in spinal toads during exercise may be due to direct mechanical effects of venous return on the heart.
Assuntos
Glândulas Suprarrenais/metabolismo , Bufonidae/sangue , Epinefrina/sangue , Norepinefrina/sangue , Condicionamento Físico Animal/fisiologia , Glândulas Suprarrenais/citologia , Glândulas Suprarrenais/inervação , Animais , Pressão Sanguínea/fisiologia , Bufonidae/fisiologia , Células Cromafins/metabolismo , Denervação , Epinefrina/metabolismo , Feminino , Frequência Cardíaca/fisiologia , Masculino , Norepinefrina/metabolismo , Medula Espinal/cirurgia , Nervos Esplâncnicos/cirurgiaRESUMO
A oclusäo e reperfusäo das artérias esplâncnicas ocasiona choque circulatório, causado principalmente pelo aumento de permeabilidade vascular e pela agressäo celular provocada por radicais livres derivados do oxigênio. Este estudo tem por finalidade verificar a açäo do extrato de Ginkgo biloba (Egb-761) e do amido hidroxietílico (AHH) na prevençäo do choque circulatório produzido pela isquemia e reperfusäo de órgäos esplâncnicos. O Egb-761 tem propriedades antioxidantes relatadas na literatura. O AHH, tem sido utilizado como recurso terapêutico do choque hipovolêmico. Ratos anestesiados receberam infusäo contínua de Egb-761 ou AHH, sendo submetidos à isquemia (oclusäo do tronco celíaco, artéria mesentérica superior e artéria mesentérica inferior por 30 minutos) e reperfusäo (por 90 minutos) dos órgäos esplâncnicos. Foram feitas: análise histopatológica ileal, dosagem de malondialdeído ileal e determinaçäo contínua da pressäo arterial média (PAM). A PAM ao final do período de reperfusäo foi significativamente mais elevada nos animais tratados com Egb-761 e AHH, que no grupo controle (F=18,29; p<0,001). Näo houve diferença entre os grupos tratados e controle quanto à dosagem de MDA (H=4,61; p>0,10) e quanto às alteraçöes histológicas (H=6,003; p>0,10). Em conclusäo, houve melhora nas condiçöes hemodinâmicas, com atenuaçäo do choque nos ratos que receberam Egb-761 ou AHH. Novos estudos seräo necessários para se avaliar melhor as alteraçöes histológicas e para esclarecer a formaçäo de produtos finais da peroxidaçäo lipídica.
Assuntos
Animais , Masculino , Ratos , Ginkgo biloba/uso terapêutico , Isquemia/terapia , Nervos Esplâncnicos/cirurgia , Soluções Hipertônicas/uso terapêutico , Traumatismo por Reperfusão/terapia , Radicais Livres/efeitos adversos , Íleo/anatomia & histologia , Íleo/química , Isquemia/etiologia , Ratos Wistar , Reperfusão/métodos , Traumatismo por Reperfusão/etiologiaRESUMO
Spinal cord transection (SCT) delays gastric emptying (GE), and intestinal and gastrointestinal (GI) transit of liquid in awake rats. This study evaluates the neural mechanisms involved in this phenomenon. Male Wistar rats (N = 147) were fasted for 16 h and had the left jugular vein cannulated followed by laminectomy or laminectomy + complete SCT between T4 and T5 vertebrae. The next day, a test meal (1.5 ml of a phenol red solution, 0.5 mg/ml in 5% glucose) was administered by gavage feeding and 10 min later cervical dislocation was performed. Dye recovery in the stomach, and proximal, mid and distal small intestine was determined by spectrophotometry. SCT inhibited GE and GI transit since it increased gastric recovery by 71.3% and decreased mid small intestine recovery by 100% (P < 0.05). Subdiaphragmatic vagotomy, celiac ganglionectomy + section of the splanchnic nerves, i.v. hexamethonium (20 mg/kg) or yohimbine (3 mg/kg) prevented the development of the SCT effect on GE and GI transit. Pretreatment with i.v. naloxone (2 mg/kg), L-NAME (3 mg/kg) or propranolol (2 mg/kg) was ineffective. Bilateral adrenalectomy or guanethidine (10 mg/kg) increased the magnitude of the GE inhibition, while i.v. prazosin (1 mg/kg) or atropine (0.5 mg/kg) decreased the magnitude but did not abolish the GE inhibition. In summary, the inhibition of GI motility observed 1 day after thoracic SCT in awake rats seems to involve vagal and possibly splanchnic pathways.
Assuntos
Sistema Nervoso Autônomo/fisiopatologia , Fenômenos Fisiológicos do Sistema Digestório , Sistema Digestório/inervação , Esvaziamento Gástrico/fisiologia , Gastroenteropatias/etiologia , Gastroenteropatias/fisiopatologia , Motilidade Gastrointestinal/fisiologia , Traumatismos da Medula Espinal/complicações , Medula Espinal/fisiopatologia , Animais , Sistema Nervoso Autônomo/efeitos dos fármacos , Sistema Nervoso Autônomo/patologia , Fenômenos Fisiológicos Cardiovasculares/efeitos dos fármacos , Sistema Digestório/efeitos dos fármacos , Gânglios Simpáticos/fisiologia , Gânglios Simpáticos/cirurgia , Ganglionectomia/efeitos adversos , Esvaziamento Gástrico/efeitos dos fármacos , Gastroenteropatias/tratamento farmacológico , Motilidade Gastrointestinal/efeitos dos fármacos , Indicadores e Reagentes/farmacocinética , Masculino , Fenolsulfonaftaleína/farmacocinética , Ratos , Ratos Wistar , Medula Espinal/patologia , Nervos Esplâncnicos/fisiologia , Nervos Esplâncnicos/cirurgia , Simpatectomia/efeitos adversos , Vértebras Torácicas , Fatores de Tempo , Vagotomia/efeitos adversosRESUMO
Un total de 159 perros mestizos fueron distribuídos en 8 lotes de experiencia con el fin de investigar las alteraciones neurovasculares iniciales y la participación del sistema neurovegetativo en el curso evolutivo de las pancreatitis agudas. Los procedimientos utilizados y resultados obtenidos se detallan a continuación: 1. Se procedió a inducir pancreatitis agudas experimentales según dos métodos: a) inyección de bilis vesicular autóloga, en el conducto pancreático principal y b) confección de un asa ciega duodenal por exclusión a nivel del pilóro y del segmento duodenal inferior. En ambos procederes se observaron pancreatitis agudas severas com predominio de necrosis grasas en las obtenidas por inyección de bilis y con francas lesiones hemorrágicas en las producidas por oclusión duodenal. 2. El bloqueo anestésico del plexo celíaco al inibibir la conducción de estímulos a centros superiores suprimió el dolor y el shock conservando el buen estado general de los animales. No se mostró eficaz en cambio en el progreso de las alteraciones anatomopatológicos del páncreas. La resección del tronco de los esplácnicos seguida 72 horas después de la inducción de pancreatitis tuvo efectos semejantes. 3. La resección de los nervios esplácnicos seguida de un intervalo de tiempo suficiente (20 días) para la degeneración de las fibras nerviosas periféricas, antes de la provación de pancreatitis experimentales previno en forma absoluta del desnecadenamiento de las lesiones glandulares. 4. En el terreno somático, experiencias paralelas utilizando inyecciones intramusculares de esencia de trementina en miembros con o sin denervación previa, permite obtener conclusiones en todo semejantes a las anteriores, ratificando la participación directa del sistema neurovascular simpático en el proceso inflamatório en general...
Assuntos
Cães , Animais , Masculino , Pancreatite/patologia , Sistema Nervoso Autônomo/fisiopatologia , Bile , Plexo Celíaco , Hemorragia/etiologia , Necrose/etiologia , Bloqueio Nervoso , Degeneração Neural , Ductos Pancreáticos/cirurgia , Pancreatite/etiologia , Nervos Esplâncnicos/cirurgiaRESUMO
Un total de 159 perros mestizos fueron distribuídos en 8 lotes de experiencia con el fin de investigar las alteraciones neurovasculares iniciales y la participación del sistema neurovegetativo en el curso evolutivo de las pancreatitis agudas. Los procedimientos utilizados y resultados obtenidos se detallan a continuación: 1. Se procedió a inducir pancreatitis agudas experimentales según dos métodos: a) inyección de bilis vesicular autóloga, en el conducto pancreático principal y b) confección de un asa ciega duodenal por exclusión a nivel del pilóro y del segmento duodenal inferior. En ambos procederes se observaron pancreatitis agudas severas com predominio de necrosis grasas en las obtenidas por inyección de bilis y con francas lesiones hemorrágicas en las producidas por oclusión duodenal. 2. El bloqueo anestésico del plexo celíaco al inibibir la conducción de estímulos a centros superiores suprimió el dolor y el shock conservando el buen estado general de los animales. No se mostró eficaz en cambio en el progreso de las alteraciones anatomopatológicos del páncreas. La resección del tronco de los esplácnicos seguida 72 horas después de la inducción de pancreatitis tuvo efectos semejantes. 3. La resección de los nervios esplácnicos seguida de un intervalo de tiempo suficiente (20 días) para la degeneración de las fibras nerviosas periféricas, antes de la provación de pancreatitis experimentales previno en forma absoluta del desnecadenamiento de las lesiones glandulares. 4. En el terreno somático, experiencias paralelas utilizando inyecciones intramusculares de esencia de trementina en miembros con o sin denervación previa, permite obtener conclusiones en todo semejantes a las anteriores, ratificando la participación directa del sistema neurovascular simpático en el proceso inflamatório en general...(AU)