ABSTRACT
Background:Lumbar sympathectomy through radio ablation is a useful treatment of peripheral ischemia. However, clinical efficacy with respect to lower limb ulcers is not adequately established in the Indian population. The study was conducted to evaluate the role of radiofrequency ablation (RFA) of the lumbar sympathetic ganglia in healing of ischemic ulcers of the lower limb.Method:The prospective study with 63 patients registered in the General surgery department with lower limb ischemic ulcers between December 2017 July2019 were treated with RFA. Patients with cardiopulmonary disease, pregnant, congenital malformation, or skin infection at the site of intervention, or suffering from bleeding disorders, were excluded from the study. Clinical investigation of the wound was performed, and demographic data was collected. Comparative reduction in wound size was assessed through Friedman`s ANOVA (P<0.001). Difference in pain score, hospital stay, and walking distance were evaluated using Wilcoxon matched pair test (P<0.001), Unpaired t-test, and Paired t-test (P<0.05).Result:Majority of the patients were male (n=40) with a mean age of 60.93 SD14.34 years. Significant reduction in wound size, pain scores and hospital stay were observed post procedure(P<0.001). Number of RFA sessions was significantly associated with the size of the ulcer and Fontaine's classification 2 and 3 (P<0.0001).Conclusion:RFA of lumbar sympathetic ganglia is a potential treatment modality for lower limb ischemic ulcers.
Antecedentes: La simpatectomía lumbar a través de la ablación por radiofrecuencia es un tratamiento útil de la isquemia periférica. Sin embargo, la eficacia clínica con respecto a las úlceras en las extremidades inferiores no está adecuadamente establecida en la población india. El estudio se llevó a cabo para evaluar el papel de la ablación por radiofrecuencia (RFA) de los ganglios simpáticos lumbares en la curación de las úlceras isquémicas de la extremidad inferior. Método: El estudio prospectivo con 63 pacientes registrados en el departamento de cirugía general con úlceras isquémicas de las extremidades inferiores entre diciembre de 2017 y julio de 2019 fueron tratados con RFA. Los pacientes con enfermedad cardiopulmonar, malformación embarazada, congénita o infección de la piel en el lugar de la intervención, o que sufren de trastornos hemorrágicos, fueron excluidos del estudio. Se realizó una investigación clínica de la herida y se recopilaron datos demográficos. La reducción comparativa en el tamaño de la herida se evaluó a través del ANOVA de Friedman (P<0.001).Resultado: La diferencia en la puntuación del dolor, la estancia en el hospital y la distancia a pie se evaluaron mediante la prueba de par coincidente de Wilcoxon (P<0.001), la prueba t no emparejada y la prueba t emparejada (P<0.05). La mayoría de los pacientes eran varones (n-40) con una edad media de 60,93 SD14,34 años. Se observó una reducción significativa en el tamaño de la herida, las puntuaciones de dolor y la estancia hospitalaria (P<0.001). El número de sesiones de RFA se asoció significativamente con el tamaño de la úlcera y las clasificaciones 2 y 3 de Fontaine (P<0.0001).Conclusión: LA RFA de los ganglios simpáticos lumbares puede constituir una opción terapéutica para las úlceras isquémicas de las extremidades inferiores.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Ulcer/therapy , Lower Extremity , Radiofrequency Ablation/methods , Ganglia, Sympathetic , Ischemia/therapy , Prospective Studies , Analysis of Variance , IndiaABSTRACT
SUMMARY: The celiac, cranial mesenteric and celiacomesenteric ganglia of the paca (Cuniculus paca) were found between the celiac and cranial mesenteric arteries. Two predominant patterns were found: isolated celiac and cranial mesenteric ganglion and the celiacomesenteric ganglion. At the microscopic level, the ganglia are constituted by an agglomeration of neurons surrounded by capsule of connective tissue. Most of these neurons had a single eccentric nucleus. Satellite cells and mast cells were found around the soma. The mast cells were also found ar ound blood vessels and in the capsule of the ganglia.
RESUMEN: Los ganglios celíacos, mesentérico-craneales y celíaco mesentéricos de la paca (Cuniculus paca) se encontraron entre las arterias celíaca y mesentérica craneal. Se visalizaron dos patrones predominantes: celiaca aislada y ganglio mesentérico craneal y ganglio celiaco mesentérico. A nivel microscópico, los ganglios están constituidos por una aglomeración de neuronas rodeadas por una cápsula de tejido conectivo. La mayoría de estas neuronas tenían un solo núcleo excéntrico. Se encontraron células satélites y mastocitos alrededor del soma. Los mastocitos también se encontraron alrededor de los vasos sanguíneos y en la cápsula de los ganglios.
Subject(s)
Animals , Male , Female , Celiac Plexus/anatomy & histology , Cuniculidae/anatomy & histology , Ganglia, Sympathetic/anatomy & histology , Celiac Plexus/ultrastructure , Ganglia, Sympathetic/ultrastructureABSTRACT
Adjuvant radiation therapy (RT) after colorectal cancer surgery can prevent local recurrence, but has several side effects. Precise injection of drugs into the affected areas is complicated by radiation-induced fibrosis of soft or connective tissue. A 48-year-old woman experienced severe intractable perineal pain, dysuria, urinary urgency, and frequent urination after rectal cancer surgery and adjuvant RT, and was diagnosed with radiation-induced cystitis and vulvodynia. Her symptoms persisted despite two fluoroscopy-guided ganglion impar blocks. Fluoroscopy revealed atypical needle tip positioning and radiolucent dye distribution, presumably due to radiation-induced fibrosis in the target region. We performed two computed tomography (CT)-guided ganglion impar blocks by using a lateral approach, which allowed more accurate po-sitioning of the needle tip. Her pain visual analog score decreased from 9 to 3, and she recently resumed sexual intimacy. CT guidance is a viable alternative to fluoroscopy guidance when performing ganglion impar blocks in fibrotic areas.
Subject(s)
Female , Humans , Middle Aged , Colorectal Neoplasms , Connective Tissue , Cystitis , Dysuria , Fibrosis , Fluoroscopy , Ganglia, Sympathetic , Ganglion Cysts , Needles , Nerve Block , Radiotherapy , Rectal Neoplasms , Recurrence , Urination , VulvodyniaABSTRACT
There is evidence for participation of peripheral β-adrenoceptors in delayed liquid gastric emptying (GE) induced in rats by dipyrone (Dp), 4-aminoantipyrine (AA), and antipyrine (At). The present study aimed to determine whether β-adrenoceptors are involved in delayed GE induced by phenylpyrazole derivatives and the role of the prevertebral sympathetic nervous system in this condition. Male Wistar rats weighing 220-280 g were used in the study. In the first experiment rats were intravenously pretreated with vehicle (V), atenolol 30 mg/kg (ATE, β1-adrenergic antagonist), or butoxamine 25 mg/kg (BUT, β2-adrenergic antagonist). In the second experiment, rats were pretreated with V or SR59230A 2 mg/kg (SRA, β3-adrenergic antagonist). In the third experiment, rats were subjected to surgical resection of the celiac-superior mesenteric ganglion complex or to sham surgery. The groups were intravenously treated with saline (S), 240 µmol/kg Dp, AA, or At, 15 min after pretreatment with the antagonists or V and nine days after surgery. GE was determined 10 min later by measuring the percentage of gastric retention (%GR) of saline labeled with phenol red 10 min after gavage. The %GR (means±SE, n=6) values indicated that BUT abolished the effect of Dp (BUT+Dp vs V+Dp: 35.0%±5.1% vs 56.4%±2.7%) and At (BUT+At vs V+At: 33.5%±4.7% vs 52.9%±2.6%) on GE, and significantly reduced (P<0.05) the effect of AA (BUT+AA vs V+AA: 48.0%±5.0% vs 65.2%±3.8%). ATE, SRA, and sympathectomy did not modify the effects of treatments. These results suggest that β2-adrenoceptor activation occurred in delayed liquid gastric emptying induced by the phenylpyrazole derivatives dipyrone, 4-aminoantipyrine, and antipyrine. Additionally, the released neurotransmitter did not originate in the celiac-superior mesenteric ganglion complex.
Subject(s)
Animals , Male , Adrenergic beta-Antagonists/pharmacology , Anti-Inflammatory Agents, Non-Steroidal/pharmacology , Antipyrine/administration & dosage , Ganglionectomy , Gastric Emptying/drug effects , Receptors, Adrenergic, beta/metabolism , Adrenergic beta-Antagonists/administration & dosage , Ampyrone/pharmacology , Atenolol/pharmacology , Butoxamine/pharmacology , Dipyrone/pharmacology , Dose-Response Relationship, Drug , Ganglia, Sympathetic/surgery , Models, Animal , Propanolamines/pharmacology , Rats, Wistar , Sympathetic Nervous System/drug effectsABSTRACT
BACKGROUND: The location and the number of lumbar sympathetic ganglia (LSG) vary between individuals. The aim of this study was to determine the appropriate level for a lumbar sympathetic ganglion block (LSGB), corresponding to the level at which the LSG principally aggregate. METHODS: Seventy-four consecutive subjects, including 31 women and 31 men, underwent LSGB either on the left (n = 31) or the right side (n = 43). The primary site of needle entry was randomly selected at the L3 or L4 vertebra. A total of less than 1 ml of radio opaque dye with 4% lidocaine was injected, taking caution not to traverse beyond the level of one vertebral body. The procedure was considered responsive when the skin temperature increased by more than 1℃ within 5 minutes. RESULTS: The median responsive level was significantly different between the left (lower third of the L4 body) and right (lower margin of the L3 body) sides (P = 0.021). However, there was no significant difference in the values between men and women. The overall median responsive level was the upper third of the L4 body. The mean responsive level did not correlate with height or BMI. There were no complications on short-term follow-up. CONCLUSIONS: Selection of the primary target in the left lower third of the L4 vertebral body and the right lower margin of the L3 vertebral body may reduce the number of needle insertions and the volume of agents used in conventional or neurolytic LSGB and radiofrequency thermocoagulation.
Subject(s)
Female , Humans , Male , Electrocoagulation , Follow-Up Studies , Ganglia, Sympathetic , Lidocaine , Needles , Skin Temperature , SpineABSTRACT
Objective To observe the efficacy and safety of radiofrequency thermocoagulation of lumbar sympathetic ganglia combined with pregabalin in the treatment of complex regional pain syndrome(CRPS).Methods 26 patients with lower limb CRPS were selected and treated by the radiofrequency thermocoagulation of lumbar sympathetic ganglia combined with oral pregabalin capsule.The visual analogue scale (VAS)and the quality of sleep(QS)were adopted to evaluate the pain change before treatment and on 1,7,14,28,56 d after treatment.The temperature change of lower limb skin and the occurrence situation of adverse reactions were recorded.Results Compared with before treatment,the scores of VAS and QS at different time points after treatment were decreased significantly (P <0.05),the skin temperature of affected lower limb after treatment was increased significantly (P <0.05).The total effective rates on 28,56 d after treatment were 88.46% and 96.15% respectively.The adverse reactions were mainly dizziness and somnolence.No severe complications such as vascular,neural and intra-abdominal organs injury were found in the treatment process.Conclusion The radiofrequency thermocoagulation of lumbar sympathetic ganglia combined with pregabalin in the treatment of CRPS can rapidly alleviate pain,improve the patients′quality of sleep and living.
ABSTRACT
OBJECTIVE: Morphometric data for the sympathetic ganglia (SG) of the upper thoracic spine was investigated to identify the exact location of the SG in order to reduce normal tissue injury in the thoracic cavity during thoracoscopic sympathectomy. METHODS: In 46 specimens from 23 formalin-fixed adult cadavers, the authors measured the shortest distance from the medial margin of the T1, T2 and T3 SG to the most prominent point and medial margin of the corresponding rib heads, and to the lateral margin of the longus colli muscle. In addition, the distance between the most prominent point of the rib head and the lateral margin of longus colli muscle and the width of each SG were measured. RESULTS: The shortest distance from the medial margin of the SG to the prominent point of corresponding rib head was on average 1.9 mm on T1, 4.2 mm, and 4.1 mm on T2, T3. The distance from the medial margin of the SG to the medial margin of the corresponding rib head was 4.2 mm on T1, 5.9 mm, and 6.3 mm on T2, T3. The mean distance from the medial margin of the SG to the lateral margin of the longus colli muscle was 6.7 mm on T1, 8.8 mm, 9.9 and mm on T2, T3. The mean distance between the prominent point of the rib head and the lateral margin of the longus colli muscle was 4.8 mm on T1, 4.6 mm, and 5.9 mm on T2, T3. The mean width of SG was 6.1 mm on T1, 4.1 mm, and 3.1 mm on T2, T3. CONCLUSION: We present morphometric data to assist in surgical planning and the localization of the upper thoracic SG during thoracoscopic sympathectomy.
Subject(s)
Adult , Humans , Cadaver , Ganglia, Sympathetic , Head , Muscles , Ribs , Spine , Sympathectomy , Thoracic Cavity , Thoracic Vertebrae , ThoracoscopyABSTRACT
Objective To observe the therapeutic effect of irradiation of the lumbar sympathetic ganglia by linear polarized light for the lower-limb neuropathie pain.Methods The lumbar sympathetic ganglia was irradiated by super liar therapeutic equipment focused on L_2 as the center,once a day,20 min each time for 30 days.Skin temperature on the lower limb,VAS score and pain threshold were evaluated.Results Compared to before,the skin temperature increased (P<0.01),VAS decreased (P<0.01),and pain threshold incresed(P<0.01).Conclusion The super lizer irradiation has a good therapeutic effect on lower extremity neuropathic pain
ABSTRACT
The origin of sympathetic and sensory nerves innervating heart in the cat was investigated using HRP (Horseradish peroxidase) and WGA-HRP (Wheat germ agglutinin-horseradish peroxidase) as neuronal tracers. The neural tracers were injected into subepicardial layer and myocardium of the right atrium, left atrium, right ventricle and left ventricle, respectively. Labeled sympathetic neuronal cell bodies were found in superior cervical ganglia, middle cervical ganglia, stellate ganglia and 4th and 5th thoracic ganglia, mainly in middle cervical ganglia and stellate ganglia. Heavier labeled neuronal cell bodies were found in the middle cervical ganglia and stellate ganglia when the neural tracers were injected into left atrium, right ventricle and left ventricle. Labeled sensory neuronal cell bodies were found in nodose ganglia and T1-T6 spinal ganglia, mainly in T1-T5 spinal ganglia. Heavier labeled neuronal cell bodies were found in the nodose ganglia when the neural tracers were injected into left atrium and right ventricle. These results may provide a neuroanatomical data on origin of sensory nerves innervating the heart of the cat.
Subject(s)
Animals , Cats , Ganglia , Ganglia, Sensory , Ganglia, Spinal , Ganglia, Sympathetic , Heart Atria , Heart Ventricles , Heart , Horseradish Peroxidase , Myocardium , Neurons , Nodose Ganglion , Sensory Receptor Cells , Stellate Ganglion , Superior Cervical Ganglion , Wheat Germ Agglutinin-Horseradish Peroxidase ConjugateABSTRACT
We present a case of ganglioneuroma arsing from the sympathetic ganglia in the pelvic cavity.
Subject(s)
Ganglia, Sympathetic , GanglioneuromaABSTRACT
Effects of a M1 receptor antagonist, pirenzepine, a M2 receptor antagonist, AF-DX116, and a nicotinic receptor antagonist, mecamylamine on the pressor responses to preganglionic sympathetic nerve stimulation(PNS) and McN-A-343 and DMPP in spinal(pithed) rabbits were investigated in order to elucidate a functional role of M1, M2 and nicotinic receptors in ganglionic transmission. Pirenzepine and AF-DX116 selectively inhibited the McN-A-343-induced pressor reponse in chlorisondamine-treated rabbit and the BCh-induced bradycardia, respectively. Electrical stimulations of preganglionic sympathetic outflow at T8 level produced increases in blood pressure. Pirenzepine(3 microgram/kg) significantly inhibited the PNS-induced pressor response and the degree of inhibition was not changed by increasing the doses to 100 microgram/kg. AF-DX116(100 microgram/kg) had no effect on the PNS-induced pressor response. Mecamylamine inhibited the PNS-induced pressor response in a dose-dependent manner. The inhibitory action of mecamylamine was significantly augmented by combined-treatment with pirenzepine(30 microgram/kg) but AF-DX116(100 microgram/kg) did not affect the inhibitory action of mecamylamine. McN-A-343 and DMPP elicited pressor response in the spinal rabbit. Pirenzepine and AF-DX116 dose-dependently inhibited the McN-A-343-induced pressor response but they did not affect DMPP-induced pressor response. Mecamylamine inhibited both pressor responses induced by Mc-N-343- and DMPP. These results suggest that not only nicotinic receptors but also M1 receptors play a facilitatory role in ganglionic transmission but M2 receptors do not contribute the transmission in spinal(pithed) rabbits.
Subject(s)
Rabbits , (4-(m-Chlorophenylcarbamoyloxy)-2-butynyl)trimethylammonium Chloride , Blood Pressure , Bradycardia , Dimethylphenylpiperazinium Iodide , Electric Stimulation , Ganglia, Sympathetic , Ganglion Cysts , Mecamylamine , Pirenzepine , Receptors, NicotinicABSTRACT
The effects of Cu2+ on superior cervical sympathetic ganglion of rabbits were studied by the sucrose-gap method. Cu2+ at cumula- tive concentration inhibited ganglion action potentials. IC50 of Cu2+ was 0.26 mmol/L. The effects of Cu2+ were antagonized by neostig-miae and L-cystein, while enhanced under 1/2[Ca2+] and reduced under 3[Ca2+] .Cu2+ inhibited ganglionic N wave and P wave,without affecting LN wave.
ABSTRACT
The effect of Sin on the transmission of the impulses through isolated rabbit superior cervical sympathetic ganglia in comparison with that of curare by the sucrose - gap method was studied.Inhibi -tory effect of Sin on the action potential was dose-dependent but no effect on the excitability and conductivity of preganglionic nerves. The ID50 of Sin and curare were 1.2 mM and 0.2 mM, respectively. The effect of Sin was reduced in high Ca2+ concentration solution, and enhanced under Ca2+ free solution. Neostigmine antagonized the effect of Sin.
ABSTRACT
Objective:To observe the expression of dopamme beta hydroxylase (DBH) in the lumbar sympathetic ganglia neurons of the patients with Buerger's disease of lower limb.Methods:The DBH expression of the neurons in lumbar sympathetic ganglia of 14 patients with Buerger's disease were observed by immunohistochemistry staining.11 patients without it served as the controls.Results:The DBH expression of the patients were reinforced that of control group.Conclusion:The enhanced expression of DBH may result in vasospasm,accelerating the development of Buerger's disease.
ABSTRACT
Using the conventional intracellu-lar recording techniques in the rat superior cervical ganglion, the effects of 9-amino-1,2,3,4-tetrahydroacridine(THA) on cholinergic transmission were studied. By superfusion of THA 0. 1~1 ?mol ?L-1(n = 26), the f-EPSPs evoked by preganglionic stimulation were facilitated, while 50~100 ?mol-L-1(n= 17) inhibited in a concentration-dependent manner, but 10 ?mol?L-1in 46% cells (n=11) increased and another 54% inhibited. Also exogenous ACh-induced potentials (n=27) were enhanced with THA 0. 1~10 ?mol?L-1, and in 60% (n=10) with 50~100 ?mol?L-1but another 40% depressed. In 7 cells, no enhancement of carbachol-inducedpotentials were found with THA 1~100 ?mol-L-1, while depression in 5 cells by 50~100 ?mol?L-1was observed. Pretreatment of atropine (1?mol?L-1) only partially eliminated THA inhibition on f-EPSPs but not ACh-or carbachol-induced potentials. It was suggested that THA facilitated cholinergic transmission by its anti-cholinesterase action and inhibited by both pre-and postsynaptic mechanism at different concentration levels.
ABSTRACT
Sophoramine ( Sa ) is an alkaloid from sophora alopecuroides. Linn., in anesthetize animals ( cat, rat and rabbit), intravenous adminstra-tion of Sa reduced rapidly and markly the arterial blood pressure. The mechanism of hypotension effect of Sa is mainly attributable to its sympathetic ganglionic blocking and direct vasodilatation. Experiment on the isolated hearts of guinea pig revealed that Sa produced negative chronotropic and positive inotropic action, and increased coronary flow simultaneously.In a study of experimental arrhythmia in animals,we observed that Sa could reduce the arrhythmia induced by aconitine in rats and decreased the incidence of ventricular fibrillation induced by chloroform in mice.
ABSTRACT
The work was carried out to investigate the effects of clonidine on Ach quantal release of presynaptic nerve terminals in guinea pig celiac ganglia in vitro by means of intracellular recording technique. After perfusion of celiac ganglia with clonidine ( 10?mol/L ) for 7 ~10 min, the frequency of spontaneous miniature excitatory postsynaptic potentials ( mEPSP ) which was increased by high K+ (15 mmol/L ) , diminished about 35% with little change in amplitude. Under condition of low Ca2+( 0.5mmol/L )/high Mg2+( 5.5mmol/L ) presynaptic nerve was repetitively stimulated by 200 pulses ( 1 Hz), the failure number of EPSP increased from 82 to 145 in 200 stimuli and the quantal content ( m ) decreased about 62% with little change in quantal size ( q ) under clonidine ( 10?mol/L ) action. It is indicated that clonidine can decrease Ach auantal release from presynaptic nerve terminals without effecting Ach content in vesicles, and is one of the mechanisms for depressant effect of clonidine on synaptic transmission of the sympathetic ganglia.