Blood Pressure Responses to Endovascular Stimulation: A Potential Therapy for Autonomic Disorders With Vasodilatation.

BACKGROUND: We have previously shown that sympathetic ganglia stimulation via the renal vein rapidly increases blood pressure. This study further investigated the optimal target sites and effective energy levels for stimulation of the renal vasculatures and nearby sympathetic ganglia for rapid increase in blood pressure. METHODS: The pre-study protocol for endovascular stimulations included 2 minutes of stimulation (1-150 V and 10 pulses per second) and at least 2 minutes of rest during poststimulation. If blood pressure and/or heart rate were changed during the stimulation, time to return to baseline was allowed prior to the next stimulation. RESULTS: In 11 acute canine studies, we performed 85 renal artery, 30 renal vein, and 8 hepatic vasculature stimulations. The mean arterial pressure (MAP) rapidly increased during stimulation of renal artery (95 ± 18 mmHg vs. 103 ± 15 mmHg; P < 0.0001), renal vein (90 ± 16 mmHg vs. 102 ± 20 mmHg; P = 0.001), and hepatic vasculatures (74 ± 8 mmHg vs. 82 ± 11 mmHg; P = 0.04). Predictors of a significant increase in MAP were energy >10 V focused on the left renal artery, bilateral renal arteries, and bilateral renal veins (especially the mid segment). Overall, heart rate was unchanged, but muscle fasciculation was observed in 22.0% with an output >10 V (range 15-150 V). Analysis after excluding the stimulations that resulted in fasciculation yielded similar results to the main findings. CONCLUSIONS: Stimulation of intra-abdominal vasculatures promptly increased the MAP and thus may be a potential treatment option for hypotension in autonomic disorders. Predictors of optimal stimulation include energy delivery and the site of stimulation (for the renal vasculatures), which informs the design of subsequent research.

Surgical techniques to prevent reflux esophagitis in proximal gastrectomy reconstructed by esophagogastrostomy with preservation of the lower esophageal sphincter, pyloric and celiac branches of the vagal nerve, and reconstruction of the new His angle for early proximal gastric cancer.

PURPOSE: This article describes the surgical techniques to prevent reflux esophagitis (RE) after proximal gastrectomy reconstructed by esophagogastrostomy (PGE) preservation of the lower esophageal sphincter (LES) and both pyloric and celiac branches of the vagal nerve (PCVN), and reconstruction of the new His angle (HA) for early proximal gastric cancer (PGC). METHODS: Twenty patients after PGE were divided into 2 groups (group A: 10 patients without preserved LES and PCVN for advanced PGC; group B: 10 patients with preserved LES and PCNV and the addition of a new HA for early PGC). A postoperative interview on gastroesophageal reflux disease (GERD) and satisfaction with this procedure and the collection of endoscopic findings for RE and stasis of the remnant stomach (SRS) were conducted 1 year after PGE in groups A and B. RESULTS: The rates of proton pump inhibitor administration and the symptoms of GERD, RE and SRS in group A were significantly higher than those in group B (p = 0.0433, p = 0.0190, p = 0.0253, p = 0.0190, respectively). Seven out of 10 patients in group A voiced dissatisfaction. Patients in group B were significantly more satisfied with this procedure than those in group A (p = 0.0010). CONCLUSION: This method is useful for preventing postoperative GERD including RE in early PGC patients.

Cod CGRP and tachykinins in coeliac artery innervation of the Atlantic cod, Gadus morhua: presence and vasoactivity.

The presence and vasoactive effects of native calcitonin gene-related peptide (CGRP), substance P (SP), and neurokinin A (NKA) were studied on isolated small branches of the coeliac artery from Atlantic cod, Gadus morhua, using immunohistochemistry and myograph recordings, respectively. Immunohistochemistry revealed nerve fibers containing CGRP- and SP/NKA-like material running along the wall of the arteries. CGRP induced vasorelaxation of precontracted arteries with a pD(2) value of 8.54 +/- 0.17. Relaxation to CGRP (10(-8) M) was unaffected by L-NAME (3 x 10(-4) M) and indomethacin (10(-6) M) suggesting no involvement of nitric oxide or prostaglandins in the CGRP-induced relaxation. SP and NKA (from 10(-10) to 3 x 10(-7) M) contracted the unstimulated arteries at concentrations from 10(-8) M and above in 42% and 33%, respectively, of the vessels. It is concluded that the innervation of the cod celiac artery includes nerves expressing CGRP-like and tachykinin-like material, and that a vasodilatory response to CGRP is highly conserved amongst vertebrates while the response to tachykinins is more variable.

Detection of neuronal uptake of [3H]dopamine in the rabbit celiac artery.

[3H]Dopamine ([3H]DA) is specifically taken up by slices of rabbit celiac artery. Corticosterone, a selective inhibitor of extraneuronal uptake processes, was found to reduce the uptake of the labelled catecholamine by about 30%. Desimipramine, an inhibitor of uptake processes in noradrenergic neurons, caused a decrease of [3H]DA uptake of about 35%. Benztropine, an inhibitor of uptake processes in dopaminergic neurons reduced [3H]DA uptake by about 30%. The neuronal uptake of [3H]DA was completely inhibited by chemical sympathectomy or by simultaneous incubation of the slices with desimipramine and benztropine. Norepinephrine had a competitive effect on [3H]DA uptake and benztropine inhibited [3H]norepinephrine uptake by 32%. The results are consistent with the existence of a double noradrenergic and dopaminergic innervation of the rabbit celiac artery.

Celiac compression syndrome: tailored therapy based on intraoperative findings.

BACKGROUND: The role of surgical treatment for the relatively rare celiac artery compression syndrome remains controversial. We used a tailored operative approach based on intraoperative findings. STUDY DESIGN: We retrospectively reviewed operative and follow-up data from the seven patients at our institution who underwent tailored operative intervention for celiac artery compression syndrome during a 15-year period. RESULTS: In all patients, decompression of the celiac axis was accomplished by division of the sympathetic neural fibers and the median arcuate ligament. In five cases in which intraoperative evaluation demonstrated compromised celiac artery flow after decompression, revascularization was also performed: three patients underwent an aortoceliac bypass, which was performed with a polytetrafluoroethylene graft in two cases and a vein graft in one case; the fourth patient had an angioplasty using a knitted polyester fiber patch, and the fifth patient underwent aortic reimplantation of the celiac artery. The tailored operative approach (decompression alone or with revascularization) for celiac artery compression syndrome, determined on the basis of intraoperative findings, provided complete (immediate and long-term) relief of preoperative symptoms in all seven patients. CONCLUSIONS: The tailored approach to operative intervention for celiac artery compression syndrome, which is based on individual operative findings, offers patients an excellent chance for immediate and long-term freedom from symptoms.

[Effect of periarterial sympathectomy of the celiac trunk and its branches on the motor function of the stomach]. / Vliianie periarterial'noi simpatéktomii chrevnogo stvola i ego vetvei na motornuiu funktsiiu zheludka.

The motor function of the stomach was investigated in 45 patients who were subjected to periarterial sympathectomy of the celiac trunk and its branches for the abdominal pain syndrome. Changes in the motility were studied in near and late terms after operation (1-2 years). The elevated tonus of the stomach was found to be even in the initial hypokinesis and of spastic character in the initially normal tonus. The increased peristaltic activity was noted in late terms. The changes of the gastric motility were responsible for the outcomes of operations.

[Effect of periarterial sympathectomy and decompensation of the celiac trunk on gastric secretion in the abdominal pain syndrome]. / Vliianie periarterial'noi simpatektomii i dekompensatsii chrevnogo stvola na zheludochnuiu sekretsiiu pri abdominal'nom bolevom sindrome.

The gastric secretion was investigated after periarterial sympathectomy and decompression of the celiac trunk in 50 patients. It was shown that basal and stimulated secretion was persistently increased in cases with intact structure of the celiac plexus, while in cases with degenerative changes with fibrosis of the ganglia and conductors the gastric secretion was not found to significantly change. The data obtained should be taken into consideration when operating upon the celiac artery and celiac plexus.

Otolithic activation on visceral circulation in humans: effect of aging.

Engagement of the otolith organs elicits differential activation of sympathetic nerve activity and vascular responses to muscle and skin in humans. Additionally, aging attenuates the otolith organ-mediated increases in muscle sympathetic nerve activity in older adults. In this study, we hypothesized that 1) the vestibulosympathetic reflex (VSR) would elicit visceral vascular vasoconstriction and 2) visceral vascular response to the VSR would be attenuated in older subjects compared with young. To test these hypotheses, heart rate, mean arterial blood pressure, and renal, celiac trunk, and superior mesenteric arterial blood velocity (Doppler ultrasound) were measured in 22 young (25+/-1 yr) and 18 older (65+/-2 yr) healthy subjects during head-down rotation (HDR), which selectively activates the otolith organs. Mean arterial pressure and heart rate did not change from baseline during HDR in young or older subjects. Renal blood velocity (Delta -2+/-1 cm/s) and vascular conductance (Delta -0.03+/-0.01 cm.s(-1).mmHg(-1)) significantly decreased from baseline during HDR (P<0.05) in young subjects. In contrast, renal blood velocity and conductance did not change in older subjects (Delta -0.2+/-1 cm/s and Delta0.02+/-0.08 mmHg.cm(-1).s(-1), respectively) during HDR. Superior mesenteric and celiac blood velocity and vascular conductance did not change in response to HDR in either the young or older subjects. These data suggest that renal vasoconstriction occurs during otolith organ activation in young but not older humans. Together with our previous studies, we conclude that the VSR elicits a diverse patterning of sympathetic outflow that results in heterogeneous vascular responses in humans and that these responses are significantly attenuated in older humans.

[Nervous apparatus of the walls of the celiac trunk and its branches in man]. / Nervnyi apparat stenok chrevnogo stvola i ego vetvei u cheloveka

The impregnation methods in total laminated preparations and histological sections were used to study the nervous apparatus of the celiac trunk and its branches in humans of either sex and different age. It consists of milti- and unipolar cells, periadventitial, adventitial and muscular nervous plexuses, separate nerve trunks and plexuses and single myelinated and non-myelinated nerve fibres terminating with non-encapsulated and encapsulated nerve endings.

[Status of the celiac plexus in patients with extravasal compression of the celiac trunk and its role in the etiology of pain syndrome]. / Sostoianie chrevnogo spleteniia u bol'nykh s ékstravazal'noi kompressiei chrevnogo stvola i ego rol' v geneze bolevogo sindroma.

The technique and results of surgical treatment of 109 patients with extravasal compression of the celiac trunk (ECCT), which in 77 patients was combined with a duodenal ulcer, are described. In the celiac plexus of the patients with ECCT, the inflammatory-sclerotic changes of a different degree of pronouncement were revealed. It was established that periarterial sympathectomy of the celiac artery and its branches had an essential effect on the state of gastric functions. In patients after isolated transection of a median phrenic ligament, the changes in gastric functions were not sharply pronounced.

Neuropeptide Y effects on vasorelaxation and intestinal contraction in the Atlantic cod Gadus morhua.

Neuropeptide Y (NPY) has prominent cardiovascular effects in mammals and sharks, but no such effect has previously been demonstrated in any teleost fish. In the Atlantic cod, we found that cod NPY (10(-10)-10(-6) M) relaxed celiac arteries precontracted with epinephrine, and weak contractions were elicited in intestinal ring preparations. A few NPY-immunoreactive nerve fibers were present along small gut arteries. The results suggest that cod NPY produces vasorelaxation both by a direct action on smooth muscle and by release of prostaglandins, but with no involvement of nitric oxide, leukotrienes, or endothelium-derived relaxing factors. An additional indirect effect involving another neurotransmitter may occur. Cod NPY (10(-7) M) and human NPY (10(-7) M) had identical effects on the vessels. Small differences only in the effects of porcine [Leu(31),Pro(34)]NPY, NPY-(13-36), and cod NPY suggest the presence of a Y(1) subfamily receptor, similar to the zebrafish Ya receptor. A physiological role for NPY in teleost vasculature is concluded, but surprisingly the effect, a vasodilation, is opposite to that in mammals and is mediated by prostaglandins.

Actions of PGE2 and indomethacin on adrenergic neuroeffector transmission in the rabbit coeliac artery.

In the present study we have investigated the pre- and post-synaptic actions of PGE2 and indomethacin on the adrenergic transmission in isolated coeliac arteries of rabbits. The artery segment was preloaded with (3H)NA and suspended in an organ bath (37 degrees C, 5% CO2 - 95% O2, isometric recording). The preparation was superfused with Krebs-solution containing the uptake blockers cocaine and corticosterone. To release neurotransmitter, the artery was stimulated by electrical square-wave pulses (0.5 ms, 5 Hz, 60 s) using platinum wire electrodes. The perfusate was collected in 3 or 6 min samples. The outflow of labelled neurotransmitter was expressed in pmol/3 min. Inhibition of endogenous prostaglandin-biosynthesis by indomethacin (3/mumol/l) potentiated the contractile responses to nerve stimulation (57 +/- 15%, n = 4), but did not influence the release of NA (the release ratio was 1.02 +/- 0.03, n = 4). The endogenous prostaglandins may modulate vascular neuroeffector transmission postjunctionally, because cyclooxygenase inhibition did not cause any change in transmitter release. The effects of exogenous PGE2 on adrenergic transmission and contraction were also studied. In this case, indomethacin was present to minimize the potential complicating actions of endogenous prostanoids. At low concentrations (1, 3 and 10 nmol/l) PGE2 dose-dependently inhibited vasoconstrictor responses to nerve stimulation (IC50 = 4.7 +/- 1.5 nmol/l, n = 4), but was ineffective in influencing transmitter release (the stimulation evoked release ratios were 0.95 +/- 0.05, 1.00 +/- 0.00 and 0.93 +/- 0.11, n = 4, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Vip-induced relaxation of small arteries of the rainbow trout, Oncorhynchus mykiss, involves prostaglandin synthesis but not nitric oxide.

Small arteries (internal diameter 376 +/- 69 microns) from the proximal intestine region of the rainbow trout were mounted in a myograph apparatus where changes in isometric tension could be recorded. VIP (vasoactive intestinal polypeptide) caused a concentration-dependent relaxation (10(-9)-3 x 10(-7) M) of vessels precontracted with the alpha-adrenoceptor agonist phenylephrine (10(-5) M). The nitric oxide synthase inhibitor L-NAME (10(-4) M) did not affect the VIP-relaxation, neither did the lipoxygenase inhibitor esculetin (10(-5) M). However, the cyclooxygenase inhibitor indomethacin (10(-6) M) shifted the concentration-response curve significantly to the right. The VIP-relaxation was still present after mechanical removal of the endothelium. Sodium nitroprusside (10(-9)-10(-6) M) caused a concentration-dependent relaxation of the precontracted vessel, indicating the presence of soluble guanylate cyclase in the vascular smooth muscle cells. VIP-immunoreactivity was found in varicose nerve fibers in these vessels, but nitric oxide synthase-immunoreactivity could not be demonstrated. These results suggest that in rainbow trout, as in mammals, VIP is an endogenous vasodilating neuropeptide. No endothelium-dependent mechanism seems to be involved, neither is production of nitric oxide. Instead the relaxation is mediated, at least in part, via prostaglandin synthesis.

Origin of inferior phrenic arteries in the celiac trunk

RESUMEN: El conocimiento de las variaciones anatómicas arteriales es de gran importancia para los diagnósticos clínico, radiológico y quirúrgico. Con relación a las arterias frénicas inferiores que irrigan el diafragma, se tiene conocimiento que éstas presentan variaciones referentes a su origen. Disecamos la cavidad abdominal de 89 cadáveres adultos de ambos sexos, de los cuales 69 fueron fijados en solución de formalina a 10%, y 20 no fijados. Los cadáveres fijados fueron disecados en los laboratorios de Anatomía de la Universidad Federal de São Paulo-UNIFESP, en la Universidad de Santo Amaro-UNISA, y en la Universidad Lusíadas de Santos, UNILUS. Los cadáveres no fijados fueron disecados en los Servicios de Verificación de Óbitos de la capital (USP y UNIFESP), Brasil. Se verificó la emisión de arterias frénicas inferiores a partir del tronco celíaco y el lugar de origen de éstas. Los resultados obtenidos indicaron la presencia de arterias frénicas inferiores en 31 (34.83%) de los 89 cadáveres. En los otros 58 (65.17%) el tronco celíaco no emitió tal ramo. También se verificó en 19 (21.35%) de los 89 cadáveres, la arteria frénica inferior con origen en el contorno izquierdo del tronco celíaco, en 5 (5.62%) ésta presentaba su origen en el contorno derecho y en 7 (7.86%) emitía dos arterias frénicas, mientras que 5 de éstas se originaban separadamente de cada lado del tronco celíaco y 2 (2.25%) de un único tronco. Estos resultados permiten considerar el origen de las arterias frénicas inferiores en el tronco celíaco como una variación anatómica.