Evaluation of brachial plexus fascicles involvement on infraclavicular block: unfixed cadaver study.

BACKGROUND AND OBJECTIVES: This study shows how the diffusion of the anesthetic into the sheath occurs through the axillary infraclavicular space and hence proves the efficacy of the anesthetic block of the brachial plexus, and may thereby allow a consolidation of this pathway, with fewer complications, previously attached to the anesthesia. MATERIALS AND METHODS: 33 armpits of adult cadavers were analyzed and unfixed. We injected a solution of neoprene with latex dye in the infraclavicular space, based on the technique advocated by Gusmão et al., and put the corpses in refrigerators for three weeks. Subsequently, the specimens were thawed and dissected, exposing the axillary sheath along its entire length. RESULTS AND DISCUSSION: Was demonstrated involvement of all fasciculus of the plexus in 51.46%. In partial involvement was 30.30%, 18.24% of cases the acrylic was located outside the auxiliary sheath involving no issue. CONCLUSIONS: The results allow us to establish the infraclavicular as an effective and easy way to access plexus brachial, because the solution involved the fascicles in 81.76% partially or totally, when it was injected inside the axillary sheath. We believe that only the use of this pathway access in practice it may demonstrate the efficiency.

Análise comparativa entre a vascularização arterial ventricular e do nó sinoatrial em corações de cães / Comparative analysis between both ventricular and sinoatrial node arterial vascularization in heart of dogs

Utilizamos nesta pesquisa 40 corações de cães adultos, machos e fêmeas, de idades variadas, que não portavam nenhuma afecção cardíaca. Os corações tiveram as artérias coronárias injetadas, separadamente, com Neoprene Látex 450, corado com pigmento vermelho, e posteriormente dissecados. Em todas estas preparações verificamos que na vascularização dos ventrículos predominava a artéria coronária esquerda que fornecia os ramos interventriculares paraconal e subsinuoso. Já, a região ocupada pelo nó sinoatrial ficava mais frequentemente (17 vezes, 42,5%) na dependência do ramo proximal atrial esquerdo ou de colateral deste vaso, oriundo do ramo circunflexo esquerdo, ou deste vaso associado ao ramo distal atrial direito (8 vezes, 20%), procedente do ramo circunflexo direito. Com menor frequência (14 vezes, 30%), a área tomada pelo nó sinoatrial, encontramos apenas colaterais do ramo circunflexo direito, mais exatamente somente o ramo distal atrial direito (10 vezes, 25%), apenas o ramo proximal atrial direito (3 vezes, 7,5%) ou ainda exclusivamente o ramo intermédio atrial direito (1 vez, 2,5%). Em um único caso (1 vez, 2,5%) no território do nó sinoatrial observamos apenas colateral do ramo circunflexo esquerdo, isto é o ramo distal atrial esquerdo. A análise destes resultados permite concluir, que nesta espécie não existe qualquer tipo de relação entre o tipo de vascularização dos ventrículos e a irrigação do nó sinoatrial. Sendo assim, considerar os ramos ventriculares isoladamente não é suficiente para um entendimento clínico-cirúrgico aplicado, uma vez que os ramos atriais apresentam uma importante contribuição para a vascularização do nó sinoatrial.

We analyzed 40 hearts of adult dogs, males and females of different ages, without cardiac disease. The hearts had the coronary arteries inject using Neoprene Latex 450, colored with red pigment, and which was then dissected. In the ventricular vascularization the left coronary artery was predominant and gave rise to the paraconal interventricular and subsinuous branches. The region occupied by the sinoatrial node was most frequently (17 times, 42.5%) in dependence of the left atrial proximal branch or in the collateral branch of that vessel, coming from the left circumflex branch, or this vessel was associated with the right atrial distal branch (8 times, 20%). With less frequency (14 times, 30%), in the area occupied by the sinoatrial node we found only the collaterals of the right circumflex branch, only the right atrial distal branch (10 times, 25%), only the right atrial proximal branch (3 times, 7.5%) or exclusively the right atrial intermediary branch (once, 2.5%). In just one case (once, 2.5%) in the area of the sinoatrial node we observed only the collateral of the left circumflex branch, i.e. the left atrial distal branch. According to our results we concluded that in this specie there is no relationship between the type of ventricular vascularization and irrigation of the sinoatrial node. In doing so, to consider just the ventricular branches is not sufficient for a clinical and surgical applied understanding, since the atrial branches make an important contribution to the sinoatrial node vascularization.

The vascular system of the upper eyelid. Anatomical study and clinical interest.

Thorough knowledge of the vascular supply is indispensable for repair and oncologic surgery of the eyelids, and has a significant impact on the management of complex defects of this region. This anatomic study was performed with five fresh cadavers after arterial injection of coloured neoprene latex. The distribution of the vascular system of the upper eyelid was examined after dissection and photographic study. It is made up of three arcades: the preseptal arcade, the supratarsal arcade, and the marginal arcade, under the orbicularis oculi muscle. These arcades are supplied by branches of the ophthalmic artery (supraorbital artery, supratrochlear artery and medial palpebral artery) and branches of the facial artery and temporal artery. Small vertical branches arising out of these arcades provide an anastomotic network. This anatomical study aimed to describe the vascular system of the upper eyelid in order to search for constant features and to map the blood supply of the principal upper lid flaps.

[Primary and experimental study of a new treatment for hepatolithiasis by injection of resin in the intrahepatic bile duct].

In the treatment of hepatolithiasis, it is sometimes difficult to remove the stones completely and residual stones are closely related to the prognosis. In cases with residual stones, cholangitis frequently recurs and sometimes it causes fatal hepatic failure. We postulated that filling the hepatic bile duct with resin may be useful for the prevention of the progress of this disease. This experiment is the preliminary study on this new treatment for hepatolithiasis. After the injection of Neoprene resin into the left intrahepatic bile duct of a mongrel dog, histological changes of the liver and biochemical changes in peripheral blood were serially analyzed. After six months, the Neoprene plug remained in place. In the lobe treated with Neoprene, volume and weight decreased, and fibrosis around the bile duct and interlobular connective tissue increased, while, the number of hepatocytes was not changed. There was neither abscess nor biloma in the liver. Blood analysis revealed only a transitional increase of GOT, GPT and ALP. No complication was caused by this treatment. From this result, we conclude that this new method may be useful for the treatment of hepatolithiasis.

Investigación de los efectos neurofisiológicos de la inhalación aguda de neoprén en el gato / Investigation of the neurophysiological effects of acute neopren inhalation in the cat

En 15 gatos encéfalo aislados o curarizados, se estudiaron los fectos neurofisiológicos de la inhalación aguda de disolventes orgánicos de neoprén (Tolueno, n-hexano, benceno). La actividad eléctrica se registró medinate electrodos implantados estereotáxicamente en hipocampo, amígdalas, formación reticular mesencefálica y núcleo caudado. Se hizo monitoreo de EEG y ECG. El disolvente orgánico fue impulsado por medio de la ventilación mecánica. La actividad electrográfica de base durante los 30 a 40 min que duró cada sesión experimental, varió desde los signos de máxima alerta hasta intensificación de sincronización modulada que alternó con desincronización. Frecuentemente esta actividad estuvo desfasada entre las diversas estructuras estudiadas. Se observaron descargas paroxísticas parciales principalmente en hipocampo y amígdala. También se observaron descargas paroxísticas generalizadas con orígenes aparentes distintos. En cinco gatos se hizo fotoestimulación, en dos provocó paroxismos generalizados y en uno, crisis focal amigadliana. La frecuencia óptima fue de 3 Hz

Transplante de pancreas experimental / Experimental pancreas transplantation

Experimental pancreatic transplantation was performed in dogs using different surgical techniques. Ten dogs underwent whole organ graft with diversion of exocrine secretion by anastomosis of duodenal segment to bladder (six animals) and of duodenum to a jejunal loop (four animals). Segmental pancreatic grafts were performed in 10 dogs with ductal filling with polymer in six animal and duct ligation in four dogs. It is concluded that segmental pancreatic graft with ductal filling with polymer is preferable to the other surgical techniques

[Experimental pancreas transplantation]. / Transplante de páncreas experimental.

Experimental pancreatic transplantation was performed in dogs using different surgical techniques. Ten dogs underwent whole organ graft with diversion of exocrine secretion by anastomosis of duodenal segment to bladder (six animals) and of duodenum to a jejunal loop (four animals). Segmental pancreatic grafts were performed in 10 dogs with ductal filling with polymer in six animals and duct ligation in four dogs. It is concluded that segmental pancreatic graft with ductal filling with polymer is preferable to the other surgical techniques.

Contribution of partial pancreatectomy, systemic hormone delivery, and duct obliteration to glucose regulation in canine pancreas. Importance in pancreas transplantation.

Our aim was to isolate and determine the contribution of partial pancreatectomy, systemic delivery of pancreatic hormones, and duct obliteration to glucose regulation after segmental pancreas transplantation in dogs. Fasting, postprandial, and intravenous glucose-stimulated glucose, insulin, glucagon, pancreatic polypeptide (PP), and cholecystokinin (CCK) and intravenous bombesin-stimulated PP levels were studied in beagles at three successive intervals in a crossover design. The first was 6 wk after partial (approximately 70%) pancreatectomy with intact regular enteric exocrine drainage from the duodenal pancreatic remnant, the next was 2 wk after venous transposition with systemic delivery of pancreatic hormones, and the third was 6 wk after in situ duct obliteration of the remnant. With partial pancreatectomy, K values were modestly diminished (30%), and a concomitant reduction of second-phase intravenous glucose-stimulated insulin release was observed. Other parameters were not significantly affected. Venous transposition doubled peripheral plasma levels of insulin under all conditions. Fasting glucose, PP, and CCK levels decreased slightly. Other parameters were not affected. Duct obliteration of the systemic draining pancreatic remnants seriously impaired glucose sensitivity, resulting in a 50% reduction of K values and fasting and sustained postprandial hyperglycemia (approximately 8 mM) and a 70-50% reduction (acute and overall responses, respectively) of intravenous glucose-stimulated insulin. Fasting hormone and postprandial insulin, glucagon, and CCK levels were not affected. The postprandial PP response was severely reduced, and bombesin-stimulated PP release was abolished by duct obliteration. We conclude that histological changes associated with duct obliteration are the major determinants of glucose regulation in segmental pancreas transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)

Pancreatic enzyme replacement therapy in post-pancreatectomy patients.

The occurrence of malnutrition and maldigestion was studied in nine patients who underwent pancreatoduodenectomy and sclerosis of the residual pancreatic stump with neoprene. The operation causes a complete loss of exocrine pancreatic function, but spares islet cell function. Upon discharge from the hospital, patients received pancreatin powder as a dietary enzyme supplement (18,000 lipase U/meal). Patients were again hospitalized 2 y after surgery for evaluation of nutritional status and digestive function (hospital checkup). Nutritional status was evaluated by measuring serum albumin, total iron binding capacity, and total lymphocytes. Digestive function was assessed by the D-xylose tolerance test and determination of fecal fat excretion. Patients were then discharged with pancrelipase enteric-coated microspheres (ECM) as a dietary enzyme supplement (16,050 lipase U/meal). Malnutrition, defined as the occurrence of at least two abnormal nutritional parameters, was observed in three patients at the time of the hospital checkup. Upon reevaluation of nutritional status after 6 mo on pancrelipase ECM, all patients were well nourished. The mean body weight, which had been 52.8 Kg immediately after surgery, increased to 54.9 Kg at the time of the hospital checkup (p less than 0.01) and to 58.0 Kg after six months of pancrelipase ECM therapy (p less than 0.05). At the hospital checkup, the D-xylose test was normal in all patients and steatorrhea had decreased from a mean of 32.8 g/d without enzyme supplementation to 16.7 g/d with pancrelipase therapy (16,050 lipase U/meal). The complete loss of exocrine pancreatic function following surgery was well tolerated. In fact, when patients were on pancrelipase therapy, much of the original body weight was recovered and the biochemical indices of malnutrition were normalized.

Correction of malnutrition and maldigestion with enzyme supplementation in patients with surgical suppression of exocrine pancreatic function.

We studied the occurrence and extent of malnutrition and maldigestion in 13 patients who underwent pancreatoduodenectomy (PD) and injection of Neoprene (polychloroprene) (NI) into the duct of Wirsung, which results in sclerosis of hte acinar pancreatic tissue, but spares the endocrine function. At discharge, patients under took an enzyme supplementation regimen with pancreatin (18, 00 United States Pharmacopoeia units of lipase per meal). Patients were rehospitalized 24.9 months after PD plus NI to undergo nutritional and metabolic evaluation (hospital control). Nutritional status was evaluated by measuring the serum albumin level, total iron binding capacity and total lymphocyte count. Digestive function was assessed by the D-xylose tolerance test and determination of fecal fat excretion. Patients were then discharged with pancrelipase, enteric-coated microspheres (ECM) supplementation (16,050 United States Pharmacopoeia units of lipase per meal). Malnutrition, defined as the occurrence of at least two abnormal nutritional parameters, was observed in six patients at hospital control. After six months on pancrelipase ECM, the nutritional status was re-evaluated in nine patients (three previously malnourished) who were all well nourished. The mean body weight was 84.7 per cent of usual body weight at discharge after PD plus NI and raised to 88.0 per cent at the hospital control (p less than 0.01) and to 93.7 per cent )p less than 0.05) after six months on pancrelipase ECM. At hospital control, results from the D-xylose test were normal in all patients, and steatorrhea dropped from 33.6 grams per day without enzyme supplementation to 15.3 grams per day with pancrelipase ECM (16,050 United States Pharmacopoeia units of lipase per meal). Steatorrhea was incompletely but satisfactorily corrected by pancrelipase ECM. On supplementation therapy with pancrelipase ECM, patients recover a good deal of the body weight and normalize the biochemical indices of malnutrition.

[Pancreatic duct treatment in pancreas transplantation].

To determine the utility of injection of polymers to obliterate the pancreatic duct, we examined this method and others viz, pancreatico-duodenostomy, duct ligation, and the open duct method. We performed the pancreatic duct treatment on the left portion of the pancreas in dogs without any transplantation. The right portion of the pancreas was removed. We used Neoprene and Ethibloc as injected materials. One month after the operation, the polymer injected dogs showed the same endocrine function as the duct ligated and open duct ones. However, three months after the operation, endocrine function of the polymer injected dogs improved and was better than that of the other two groups which showed no changes. The endocrine function of the polymer injected dogs had remained stable for one year and was close to that of the optimal function of pancreatico-duodenostomy. Furthermore, after operation in the polymer injected dogs, the elevated serum amylase descended to normal level. This occurred much less rapidly in the other groups. The fibrosis of the polymer injected dogs' pancreas was completed by 3 months, while the dogs in the other groups still had some degenerated exocrine tissues. Rapid destruction of exocrine tissues, induced by the injection of the polymer, appears to encourage reconstruction of endocrine tissue.

Pancreatic duct obliteration: clinical application, morphological and functional effects.

Pancreatic duct obliteration is a procedure to abolish exocrine secretion in order to prevent complications such as leakage, abscess and fistula occurring formation after diversion techniques like pancreatico-enterostomy. Pancreatic duct obliteration is applicable after all sorts of partial pancreatic resections, pancreas transplantation included. Although the method is safe, experiments have shown that not only complete exocrine atrophy is induced, but that also the endocrine architecture is destroyed. In dogs, the destruction of islet architecture leads to about 70% reduction of the insulin secreting capacity. It is not known whether such a severe reduction of endocrine function also occurs after pancreatic duct obliteration in man. This would discard duct obliteration as a procedure suitable for pancreas transplantation, since optimal endocrine pancreas function is the aim of pancreas transplantation in patients suffering from type-I diabetes mellitus.

The persisting capability for vasodilatation in duct-occluded canine pancreatic segments.

The effect of duct-obliteration and duct-obliteration induced fibrosis on the capability for vasodilatation of the pancreatic vasculature was investigated in dogs. It was demonstrated that the increase of basal blood flow through left pancreatic segments, induced by intra-arterial injection of papaverin, remained unchanged during 6 months after duct-obliteration. It is concluded that impairment of endocrine function of duct-obliterated segmental pancreatic grafts cannot be readily explained by a functional impairment of the pancreatic vessels.

Allogeneic segmental pancreas transplantation in diabetic dogs with and without occlusion of the pancreatic duct.

Currently the rate of complications in segmental pancreas transplantation is very high. Reasons for this come from technical failures and from the site of immunology. To prove the cause of technical complications, several methods were used for the allogeneic segmental pancreas transplantation in diabetic dogs. To influence the exocrine pancreas secretion in grafts, we applied the intraductal injection of Ethibloc and Neoprene and the intraperitoneal drainage. By all these approaches it was possible to ameliorate an experimental diabetes in the recipients. Clearly better results were achieved in the Ethibloc-injected and open-duct grafts. The longest function time was about 6 months. Main complications, especially in the Neoprene-injected group, were venous thrombosis, pancreatitis and graft rejection.

Progress in segmental neoprene-injected pancreas transplantation. Advantages and disadvantages of using Cyclosporin A.

We performed 39 neoprene-injected pancreatic transplants (38 segmental and 1 total) in 37 insulin-dependent diabetic recipients from October 1976 to May 1983. The best results were obtained when the pancreas was transplanted simultaneously with the kidney (25 cases). The use of Cyclosporin A (CyA) for immunosuppression did not reduce the early pancreatic failures, but it seems to have slightly improved the long-term survival. The glycaemic control was better in patients treated by CyA alone than in those receiving steroids. The main side effects of CyA were nephrotoxicity and some immunoglobulin abnormalities with or without lymphoproliferative disorders occurring after treatment with CyA and ALG.