RESUMEN
Peripheral nerve injuries are common, and full functional recovery after injury is achieved in only 10% of patients. The sympathetic nervous system plays many critical roles in maintaining bodily homeostasis, but it has rarely been studied in the context of peripheral nerve injury. The extent of postganglionic sympathetic neuronal functions in distal targets in the periphery is currently unclear. To better explore the role of sympathetic innervation of peripheral targets, a surgical "knock-out" model provides an alternative approach. Although this can be achieved chemically, chemical destruction of postganglionic sympathetic neurons can be nonspecific and dose-dependent. The use of a surgical lumbar sympathectomy in mice, once thought to be "virtually not practicable" in small animals, allows for specific targeting of postganglionic sympathetic neurons that innervate the hind limbs. This manuscript describes how to surgically remove the L2-L5 lumbar sympathetic ganglia from a mouse as a survival surgery, which reliably decreases the hind paw sweat response and the number of sympathetic axons in the sciatic nerve.
Asunto(s)
Simpatectomía , Animales , Ratones , Simpatectomía/métodos , Ganglios Simpáticos/cirugía , Región Lumbosacra/inervación , Región Lumbosacra/cirugía , Nervio Ciático/cirugía , Nervio Ciático/lesiones , Miembro Posterior/inervación , Miembro Posterior/cirugíaRESUMEN
Neurons that originate from pre-vertebral sympathetic ganglia, the splanchnic-celiac-superior mesenteric ganglion complex (SCSMG) in mouse, have important roles in control of organs of the upper abdomen. Here, we present a protocol for the isolation of the mouse sympathetic SCSMG. We describe steps for surgical incision, ganglia isolation, ganglia fine dissection, and whole-mount SCSMG after clearing-enhanced 3D (Ce3D) clearing method and immunohistochemistry. Given the importance of mice in studies of that control, this protocol aims to assist biomedical researchers in the dissection of the mouse SCSMG.
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Ganglios Simpáticos , Nervios Esplácnicos , Animales , Ratones , Ganglios Simpáticos/citología , Ganglios Simpáticos/cirugía , Nervios Esplácnicos/cirugía , Inmunohistoquímica , Disección/métodos , Neuronas/citologíaRESUMEN
PURPOSE: The results and side effects of sympathicotomy for primary palmar hyperhidrosis (PPH) can vary due to anatomical variations of the sympathetic ganglions. The aim of our study was to clarify anatomical variations of the sympathetic ganglions by near-infrared (NIR) thoracoscopy and determine their effects on sympathicotomy for PPH. METHODS: The cases of 695 consecutive patients with PPH treated with either R3 or R4 sympathicotomy either by normal thoracoscopy or by NIR fluorescent thoracoscopy between March 2015 and June 2021 were retrospectively reviewed and followed up. RESULTS: The variation rate of third and fourth ganglions was 14.7% and 13.3% on the right side and 8.3% and 11.1% on the left side. Real T3 sympathicotomy (RTS3) was more effective than real T4 sympathicotomy (RTS4) in the short-term and long-term follow-up (p < 0.001 and p < 0.001, respectively). RTS3 was more satisfactory than RTS4 in the long-term follow-up (p = 0.03), but no significant difference was found in the short-term follow-up (p = 0.24). The incidence and severity of compensatory hyperhidrosis (CH) in the areas of the chest and back in the RTS4 group were significantly lower than those in the RTS3 group according to both the short-term results (12.92% vs. 26.19%, p < 0.001; 17.97% vs. 33.33%, p = 0.002, respectively) and the long-term results (19.66% vs. 28.57%, p = 0.017; 21.35% vs. 34.52%, p < 0.001, respectively). CONCLUSIONS: RTS3 may be more effective than RTS4 for PPH. However, RTS4 appears to be associated with a lower incidence and severity of CH in the areas of the chest and back than RTS3. NIR intraoperative imaging of thoracic sympathetic ganglions may improve the quality of sympathicotomy surgeries.
Asunto(s)
Hiperhidrosis , Simpatectomía , Humanos , Resultado del Tratamiento , Simpatectomía/efectos adversos , Simpatectomía/métodos , Estudios Retrospectivos , Hiperhidrosis/cirugía , Hiperhidrosis/etiología , Ganglios Simpáticos/cirugía , Toracoscopía/métodosRESUMEN
Growing evidence suggests that the sympathetic nervous system plays an important role in cancer progression. Adrenergic innervation regulates salivary gland secretion, circadian rhythm, macular degeneration, immune function, and cardiac physiology. Murine surgical sympathectomy is a method for studying the effects of adrenergic innervation by allowing for complete, unilateral adrenergic ablation while avoiding the need for repeated pharmacologic intervention and the associated side effects. However, surgical sympathectomy in mice is technically challenging because of the small size of the superior cervical ganglion. This study describes a surgical technique for reliably identifying and resecting the superior cervical ganglion to ablate the sympathetic nervous system. The successful identification and removal of the ganglion are validated by imaging the fluorescent sympathetic ganglia using a transgenic mouse, identifying post-resection Horner's syndrome, staining for adrenergic markers in the resected ganglia, and observing diminished adrenergic immunofluorescence in the target organs following sympathectomy. This model enables future studies of cancer progression as well as other physiological processes regulated by the sympathetic nervous system.
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Ganglionectomía , Simpatectomía , Animales , Ratones , Modelos Animales de Enfermedad , Ganglios Simpáticos/cirugía , Sistema Nervioso Simpático/cirugía , Sistema Nervioso Simpático/fisiología , Ganglio Cervical Superior/cirugía , AdrenérgicosRESUMEN
Disruption in the nerve-tumor interaction is now considered as a possible anticancer strategy for treating various cancer types, particularly colorectal cancer. However, the underlying mechanisms are not still fully understood. Therefore, the present study aimed to evaluate the effects of sympathetic and parasympathetic denervation on the inhibition of colorectal cancer progression in early and late phases and assess the involvement of nerve growth factor in denervation mediated anticancer effects. One-hundred and fifty male Wistar rats were assigned into 15 groups. Seven groups comprising the control group, 1,2-dimethylhydrazine (DMH) group, sympathetic denervation group (celiac-mesenteric ganglionectomy and guanethidine sulphate administration), parasympathetic denervation group (vagotomy and atropine administration), and combination group were used in the early-stage protocol. For the late-stage protocol, eight groups comprising the control, DMH, surgical and pharmacological sympathetic and parasympathetic denervation groups, combination group, and 5-flourouracil group were considered. After 8 weeks, sympathetic and parasympathetic denervation significantly reduced ACF numbers in rats receiving DMH. On the other hand, in the late stages, parasympathetic but not sympathetic denervation resulted in significant reductions in tumor incidence, tumor volume and weight, cell proliferation (indicated by reduced immunostaining of PCNA and ki-67), and angiogenesis (indicated by reduced immunostaining of CD31 and VEGF expression levels), and downregulated NGF, ß2 adrenergic, and M3 receptors. It can be concluded that parasympathetic denervation may be of high importance in colon carcinogenesis and suggested as a possible therapeutic modality in late stages of colorectal cancer.
Asunto(s)
Atropina/administración & dosificación , Neoplasias Colorrectales/cirugía , Neoplasias Experimentales/cirugía , Vagotomía , 1,2-Dimetilhidrazina/administración & dosificación , 1,2-Dimetilhidrazina/toxicidad , Animales , Carcinogénesis/inducido químicamente , Carcinógenos/administración & dosificación , Carcinógenos/toxicidad , Colon/inervación , Colon/patología , Neoplasias Colorrectales/inducido químicamente , Neoplasias Colorrectales/patología , Progresión de la Enfermedad , Ganglios Simpáticos/efectos de los fármacos , Ganglios Simpáticos/cirugía , Ganglionectomía , Guanetidina/administración & dosificación , Humanos , Masculino , Mesenterio/inervación , Neoplasias Experimentales/inducido químicamente , Neoplasias Experimentales/patología , Sistema Nervioso Parasimpático/efectos de los fármacos , Sistema Nervioso Parasimpático/cirugía , Ratas , Ratas WistarRESUMEN
Median Arcuate Ligament Syndrome (MALS) is a rare entity characterized by severe post-prandial epigastric pain, nausea, vomiting, and/or weight loss. Symptoms have been attributed to vascular compression (celiac artery compression syndrome, CACS), but it remains controversial whether they could be secondary to neural compression. Literature review identified rare description of pathologic findings in surgery journals. The clinico-pathologic findings of four MALS patients who underwent robotic or laparoscopic surgery in our hospital are described. All our patients were female with a median age of 32.5 (range 25-55 years), and a median BMI of 23.5 kg/m2. They presented with chronic often post-prandial abdominal pain (4/4), nausea (3/4), emesis (2/4), anorexia (1/4), and weight loss (1/4). Two patients had a history of Crohn's disease. At intraoperative exploration, the celiac artery and adjacent nerves and ganglia were encased and partially compressed by fibrotic tissue in each patient. In each case laparoscopic excision of fibrotic tissue, celiac plexus and ligament division and was performed; celiac plexus nerve block was also performed in one patient. After surgical intervention, symptoms improved in three of the patients whose specimens show periganglionic and perineural fibrosis with proliferation of small nerve fibers. Our findings support neurogenic compression as a contributing factor in the development of pain and other MALS symptoms, and favor the use of MALS rather than CACS as diagnostic terminology. To further study the pathogenesis of this unusual syndrome, surgeons should submit all tissues excised during MALS procedures for histopathologic examination.
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Arteria Celíaca/patología , Plexo Celíaco/patología , Fibrosis/patología , Ganglios Simpáticos/patología , Síndrome del Ligamento Arcuato Medio/patología , Dolor Abdominal/etiología , Adulto , Índice de Masa Corporal , Arteria Celíaca/cirugía , Plexo Celíaco/cirugía , Constricción Patológica/etiología , Femenino , Fibrosis/cirugía , Ganglios Simpáticos/cirugía , Humanos , Laparoscopía/métodos , Síndrome del Ligamento Arcuato Medio/diagnóstico , Síndrome del Ligamento Arcuato Medio/cirugía , Persona de Mediana Edad , Náusea/etiología , Bloqueo Nervioso/métodos , Evaluación de Resultado en la Atención de Salud , Periodo Posprandial , Procedimientos Quirúrgicos Robotizados/métodos , Vómitos/etiología , Pérdida de PesoRESUMEN
The vagus nerve and the celiaco-mesenteric ganglia (CMG) are required for reduction of meal size (MS) and prolongation of the intermeal interval (IMI) by intraperitoneal (ip) sulfated cholecystokinin-8 (CCK-8). However, recently we have shown that the gut regulates these responses. Therefore, reevaluating the role of the vagus and the CMG in the feeding responses evoked by CCK is necessary because the gut contains the highest concentration of enteric, vagal and splanchnic afferents and CCK-A receptors, which are required for reduction of food intake by this peptide, compared to other abdominal organs. To address this necessity, we injected sulfated CCK-8 (0, 0.1, 0.5, 1 and 3 nmol/kg) in the aorta, near the gastrointestinal sites of action of the peptide, in three groups of free-feeding rats (n = 10 rats per group), subdiaphragmatic vagotomy (VGX), celiaco-mesenteric ganglionectomy (CMGX) and sham-operated, and recorded seven feeding responses. In the sham group, CCK-8 reduced MS (normal chow), prolonged the intermeal interval (IMI, time between first and second meals), increased satiety ratio (SR, IMI/MS), shortened duration of first meal, reduced total (24 hrs) food intake and reduced number of meals relative to saline vehicle. Vagotomy attenuated all of the previous responses except IMI length and SR, and CMGX attenuated all of those responses. In conclusion, the feeding responses evoked by sulfated CCK-8 require, independently, the vagus nerve and the CMG.
Asunto(s)
Conducta Animal/fisiología , Colecistoquinina/farmacología , Conducta Alimentaria/fisiología , Ganglios Simpáticos/fisiología , Fragmentos de Péptidos/farmacología , Saciedad/fisiología , Simpatectomía , Vagotomía , Nervio Vago/fisiología , Animales , Arteria Celíaca , Colecistoquinina/administración & dosificación , Conducta Alimentaria/efectos de los fármacos , Ganglios Simpáticos/cirugía , Masculino , Fragmentos de Péptidos/administración & dosificación , Ratas , Ratas Sprague-Dawley , Saciedad/efectos de los fármacos , Factores de Tiempo , Nervio Vago/cirugíaRESUMEN
The pharyngeal plexus is an essential anatomical structure, but the contributions from the glossopharyngeal and vagus nerves and the superior cervical ganglion that give rise to the pharyngeal plexus are not fully understood. The pharyngeal plexus is likely to be encountered during various anterior cervical surgical procedures of the neck such as anterior cervical discectomy and fusion. Therefore, a detailed understanding of its anatomy is essential for the surgeon who operates in and around this region. Although the pharyngeal plexus is an anatomical structure that is widely mentioned in literature and anatomy books, detailed descriptions of its structural nuances are scarce; therefore, we provide a comprehensive review that encompasses all the available data from this critical structure. We conducted a narrative review of the current literature using databases like PubMed, Embase, Ovid, and Cochrane. Information was gathered regarding the pharyngeal plexus to improve our understanding of its anatomy to elucidate its involvement in postoperative spine surgery complications such as dysphagia. The neural contributions of the cranial nerves IX, X, and superior sympathetic ganglion intertwine to form the pharyngeal plexus that can be injured during ACDF procedures. Factors like surgical retraction time, postoperative hematoma, surgical hardware materials, and profiles and smoking are related to postoperative dysphagia onset. Thorough anatomical knowledge and lateral approaches to ACDF are the best preventing measures.
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Trastornos de Deglución/diagnóstico , Ganglios Simpáticos/anatomía & histología , Nervio Glosofaríngeo/anatomía & histología , Músculos Faríngeos/anatomía & histología , Complicaciones Posoperatorias/diagnóstico , Nervio Vago/anatomía & histología , Vértebras Cervicales/anatomía & histología , Vértebras Cervicales/cirugía , Trastornos de Deglución/etiología , Discectomía/efectos adversos , Femenino , Ganglios Simpáticos/cirugía , Nervio Glosofaríngeo/cirugía , Humanos , Masculino , Músculos Faríngeos/inervación , Músculos Faríngeos/cirugía , Complicaciones Posoperatorias/etiología , Fusión Vertebral/efectos adversos , Nervio Vago/cirugíaAsunto(s)
Neoplasias de las Glándulas Suprarrenales , Ganglios Parasimpáticos , Ganglios Simpáticos , Paraganglioma , Neoplasias del Sistema Nervioso Periférico , Feocromocitoma , Neoplasias de las Glándulas Suprarrenales/diagnóstico , Neoplasias de las Glándulas Suprarrenales/genética , Neoplasias de las Glándulas Suprarrenales/metabolismo , Neoplasias de las Glándulas Suprarrenales/cirugía , Adrenalectomía/métodos , Cuidados Posteriores/métodos , Biomarcadores de Tumor/genética , Biomarcadores de Tumor/metabolismo , Niño , Ganglios Parasimpáticos/metabolismo , Ganglios Parasimpáticos/cirugía , Ganglios Simpáticos/metabolismo , Ganglios Simpáticos/cirugía , Predisposición Genética a la Enfermedad , Humanos , Paraganglioma/diagnóstico , Paraganglioma/genética , Paraganglioma/metabolismo , Paraganglioma/cirugía , Atención Perioperativa/métodos , Neoplasias del Sistema Nervioso Periférico/diagnóstico , Neoplasias del Sistema Nervioso Periférico/genética , Neoplasias del Sistema Nervioso Periférico/metabolismo , Neoplasias del Sistema Nervioso Periférico/cirugía , Feocromocitoma/diagnóstico , Feocromocitoma/genética , Feocromocitoma/metabolismo , Feocromocitoma/cirugíaRESUMEN
The thoracic sympathetic chain is implicated in several disease processes including palmar hyperhidrosis and complex regional pain syndrome. These diseases are often medically refractory and require surgical treatments including sympathectomies and ganglion blocks. The use of chemogenetic or optogenetic technologies to modulate sympathetic chain activity may be a potential treatment for these diseases. However, there is no established thoracoscopic surgical approach to deliver viral vectors into the thoracic sympathetic chain and ganglia. Our objective was to evaluate the feasibility of thoracoscopic injection of the swine sympathetic chain. Two Landrace farm pigs underwent a novel procedure for thoracoscopic sympathetic chain injections. One was non-survival and one was a five-day survival surgery. Both procedures successfully delivered methylene blue in the thoracic sympathetic chain. Over the five-day postoperative period, the animal displayed stable vital signs. Thoracoscopic targeted injections of the sympathetic chain is a feasible approach to deliver therapeutics in swine. Future studies should investigate the use of transgene expression as a potential means to control sympathetic output for the development of novel therapies for palmar or axillary hyperhidrosis, thoracic neuropathic pain syndromes and select peripheral vascular diseases.
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Ganglios Simpáticos/cirugía , Toracoscopía/métodos , Animales , Vías Autónomas , Femenino , Optogenética/métodos , PorcinosRESUMEN
The bilateral major pelvic ganglia (MPG; synonym, pelvic ganglia) are the primary source of postganglionic sympathetic and parasympathetic neurons innervating pelvic organs of rodents; the functionally equivalent structure in humans is the inferior hypogastric plexus. The major pelvic ganglia also provide the route by which lumbar and sacral sensory axons reach the pelvic organs. These complex, mixed ganglia can prove challenging to identify and dissect for further experimental study of normal autonomic mechanisms or to establish preclinical models of disease, injury or visceral pain. Here we describe a protocol to access and visualize these ganglia and their associated nerve tracts. We provide this protocol with schematics for both male and female rats, as the ganglion size and landmarks for identification differ between sexes. The protocol describes removal of the ganglion for in vitro studies, but this method can be integrated into a surgical recovery protocol for experimental interventions (e.g., nerve crush, nerve resection) or for mapping neuronal circuits (e.g., by microinjection of neural tracers). We also demonstrate the primary structures of the ganglion and its associated nerves immediately following dissection and following immunohistochemical staining.
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Disección , Ganglios Autónomos/cirugía , Tejido Nervioso/cirugía , Pelvis/inervación , Puntos Anatómicos de Referencia , Animales , Axones/fisiología , Femenino , Ganglios Simpáticos/cirugía , Masculino , Ratas Sprague-DawleyRESUMEN
BACKGROUND: Primary hyperhidrosis is defined as excessive sweating of idiopathic etiology, associated with sympathetic hyperactivity, which greatly impacts patients' quality of life (QoL). The definitive treatment for palmar and axillary hyperhidrosis (PAH) is video-assisted thoracic sympathectomy (VATS). The objective of this study was to evaluate the quality of life of patients with PAH before and after VATS according to the level of sympathectomy performed, as well as the presence of compensatory hyperhidrosis (CH) and other complications. METHODS: All patients who underwent VATS in our vascular surgery department between January 2011 and December 2016 were included in the analysis. From 120 contact attempts, 88 interviews were carried out. Patients were divided into 2 groups according to the intervened thoracic level: high thoracic ganglion (HTG; T2, T2-T3, T2-T3-T4; n = 68) and low thoracic ganglion (LTG; T3, T3-T4, T4; n = 20). The questionnaire evaluated preoperative PAH severity, the presence of CH, preoperative and postoperative QoL, and postoperative satisfaction. RESULTS: The median age of patients was 29 years, and the median follow-up period was 32 months (IQR of 34 months). Most patients had severe or very severe PAH (97.7%) and preoperative QoL was bad or very bad (95.5%). Postoperatively, QoL was significantly improved in all domains evaluated, with no differences observed between the groups. The overall percentage of complications was 11.4%, mostly pneumothorax, but there was a significantly lower incidence of complications in the HTG group (P = 0.029). Compensatory hyperhidrosis developed in 85.2% of cases, but it was only considered intolerable in 10.2%. The incidence of CH was 82.4% in the HTG group and 95% in the LTG group, with no statistically significant differences between the groups (P = 0.147). CONCLUSIONS: Palmar and axillary hyperhidrosis severely affects QoL, and video-assisted thoracic sympathectomy was proven to be effective regardless of the target ganglion resected. Although CH was frequent, it was tolerated in most cases.
Asunto(s)
Ganglios Simpáticos/cirugía , Hiperhidrosis/cirugía , Complicaciones Posoperatorias/etiología , Calidad de Vida , Sudoración , Simpatectomía/efectos adversos , Cirugía Torácica Asistida por Video/efectos adversos , Adolescente , Adulto , Femenino , Ganglios Simpáticos/fisiopatología , Humanos , Hiperhidrosis/diagnóstico , Hiperhidrosis/fisiopatología , Hiperhidrosis/psicología , Masculino , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/psicología , Factores de Riesgo , Simpatectomía/métodos , Resultado del Tratamiento , Adulto JovenRESUMEN
INTRODUCTION: Previous studies have shown that epicardial ganglionated plexi ablation (EGPA) could increase the risk of ventricular arrhythmias induced by acute myocardial ischemia. However, the long-term effect of EGPA in a canine postmyocardial infarction (MI) model is not well established. MATERIALS AND METHODS: Twenty mongrel dogs were randomly divided into two groups: an MI group (n = 10) and an EGPA group (EGPA plus MI, n = 10). EGPA was achieved by ablation of four major ganglion plexi and the ligament of Marshall. The electrocardiograph (ECG) parameters, ventricular effective refractory period (ERP), inducibility of tachyarrhythmias, and ventricular fibrillation threshold (VFT) were measured at baseline and after 8 weeks. Tyrosine hydroxylase (TH) and nerve growth factor (NGF) expression levels in the peri-infarcted zone were also determined by immunohistochemistry in both groups at the end of the study. RESULTS: No significant differences were found in electrophysiological parameters at the baseline between the two groups. At the end of the 8-week follow-up, however, the EGPA group was associated with a longer QT interval, corrected QT (QTc) interval and ventricular ERP, larger dispersion of QT, QTc, and ERP, and higher inducibility of tachyarrhythmia and VFT when compared to the MI group. In addition, the density of TH and NGF in the peri-infarcted zone was also significantly increased in the EGPA group in comparison to the MI group. CONCLUSIONS: After the 8-week follow-up, EGPA increased the ventricular arrhythmia inducibility in the canine post-MI model, likely by increasing ventricular electrophysiological instability and promoting ventricular sympathetic remodeling.
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Ablación por Catéter/efectos adversos , Ganglios Simpáticos/cirugía , Frecuencia Cardíaca , Infarto del Miocardio/complicaciones , Pericardio/inervación , Simpatectomía/efectos adversos , Taquicardia Ventricular/fisiopatología , Fibrilación Ventricular/etiología , Potenciales de Acción , Animales , Modelos Animales de Enfermedad , Perros , Ganglios Simpáticos/fisiopatología , Infarto del Miocardio/fisiopatología , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/etiología , Factores de Tiempo , Fibrilación Ventricular/diagnóstico , Fibrilación Ventricular/fisiopatologíaRESUMEN
OBJECTIVE: To investigate the short- and long-term effects of ganglion impar radiofrequency thermocoagulation (RFT) treatment in patients with chronic coccydynia. METHODS: We retrospectively analyzed the medical records of patients who underwent RFT of the ganglion impar between 2009 and 2011. Pain intensity visual numeric scale (VNS) scores and Euroqol 5D (EQ-5D) index scores were recorded pre-intervention and post-intervention at the first, sixth, and twelfth months. The differences between pre-procedural VNS scores and post-procedural VNS scores at the first, sixth, and twelfth months were evaluated. The success of the intervention was recorded as the percentage difference between the pre-intervention VNS scores and post-intervention VNS scores at the first, sixth, and twelfth months. RESULTS: The mean age of the patients, including 11 females (55%) and 8 males (45%), was 48.7 ± 14.3 years. The average follow-up duration was 17.3 ± 2.9 months. Statistically significant differences were observed between the pre- and post-procedure VNS scores (P < 0.0001). Improvements in VNS scores were correlated with improvements in EQ-5D index scores. Mid-term (sixth month) and long-term (twelfth month) evaluations after the intervention revealed that 67.4% and 61.1% of the patients had successful outcomes, respectively. CONCLUSION: Our data suggested that RFT of the ganglion impar in patients with chronic coccydynia resulted in effective outcomes, and patients who responded to RFT had significantly lower post-RFT pain scores.
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Electrocoagulación/métodos , Ganglios Simpáticos/cirugía , Dolor de la Región Lumbar/cirugía , Manejo del Dolor/métodos , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Región SacrococcígeaRESUMEN
BACKGROUND AND AIMS: Although EUS-guided celiac plexus neurolysis (EUS-CPN) is frequently performed, its efficacy for palliation of pain in pancreatic cancer is suboptimal. Recently, EUS-guided radiofrequency ablation (EUS-RFA) has been proposed as a palliative treatment option for pancreatic neoplasms. We performed a single-blind, randomized trial to compare the effectiveness of EUS-CPN and EUS-RFA for palliation of pain in pancreatic cancer. METHODS: Patients with abdominal pain because of locally advanced or metastatic pancreatic cancer underwent EUS-CPN (n = 14) or EUS-RFA (n = 12). EUS-RFA was performed using a 1F monopolar probe passed via a 19-gauge FNA needle, by targeting the area of celiac plexus or visualized ganglia. Primary outcome was pain severity as measured by the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire pancreatic cancer module (PAN26) administered pretreatment and at 2 and 4 weeks post-treatment. Secondary outcome measures were comparison of quality of life as determined by the PAN26 and EORTC Quality of Life Questionnaire core questionnaire (C30) and opioid analgesia use between the 2 groups. RESULTS: Both the PAN26 (49.0 vs 57.0, P < .001) and C30 (51.9 vs 64.4, P = .032) revealed less pain for EUS-RFA than for EUS-CPN. Also, the EUS-RFA cohort experienced significantly less-severe GI symptoms, were able to plan more for the future, and had better emotional functioning compared with the EUS-CPN group. CONCLUSIONS: Compared with EUS-CPN, EUS-RFA provided more pain relief and improved the quality of life for patients with pancreatic cancer. (Clinical trials registration number: NCT03152487.).
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Dolor Abdominal/terapia , Adenocarcinoma/complicaciones , Dolor en Cáncer/terapia , Plexo Celíaco , Ganglios Simpáticos/cirugía , Bloqueo Nervioso/métodos , Neoplasias Pancreáticas/complicaciones , Ablación por Radiofrecuencia/métodos , Dolor Abdominal/etiología , Adenocarcinoma/patología , Adenocarcinoma/secundario , Anciano , Dolor en Cáncer/etiología , Endosonografía , Etanol/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Paliativos/métodos , Neoplasias Pancreáticas/patología , Método Simple Ciego , Solventes/uso terapéutico , Cirugía Asistida por ComputadorRESUMEN
Background: Ovarian carcinoma is going with peritoneal dissemination in more than a half of the cases at diagnosis. Lymph node involvement is a poor prognostic factor limiting survival. Lumboaortic lymphadenectomy is a part of the therapeutic armamentarium, although there are discrepancies in the selection of patients and prognostic impact. We evaluate some nodal infiltration risk factors for this disease and lymphadenectomy prognostic influence. Material and methods: A retrospective study of 93 patients diagnosed with stage III ovarian cancer between 2006 and 2012. A total of 52 (55.9%) patients were selected to undergo a complete or optimal cytoreduction. Two groups were established according to absence or presence of retroperitoneal lymph nodes during preoperative diagnosis, to assess the objectives of this study. Results: Statistical analysis for clinical and histopathological variables determined prealbumin (p = 0'027) and Ca 125 (p = 0'048) were associated with the risk of nodal infiltration. No significant value was seen in the parameters related to the peritoneal spread of the cancer. Lumboaortic lymphadenectomy improved disease-free survival (25'7 ± 21'4 vs 35'6 ± 22 months) with statistical significance (p = 0'033) but did not appear to achieve outstanding changes in overall survival (39'7 ± 20'1 vs 41'9 ± 20'8 months). Conclusions: A poor nutritional status and high Ca 125 could be predictive factors of lymph node involvement. The performance of a systematic lumboaortic lymphadenectomy seems to increase disease-free survival in association with a properly debulking and absence of severe postoperative complications. A broader recruitment of patients will be needed to know a more accurate pattern of lymph node disease in order to carry out a selective indication for lymphadenectomy
Introducción: el cáncer de ovario se acompaña de diseminación peritoneal en más de la mitad de los casos al diagnóstico. La afectación ganglionar es un factor de mal pronóstico que limita su supervivencia. La linfadenectomía lumboaórtica forma parte del arsenal terapéutico aunque existen discrepancias en la selección de pacientes y su impacto pronóstico. Se pretende evaluar algunos factores de riesgo de infiltración nodal para esta enfermedad y la influencia pronóstica de dicha linfadenectomía. Material y métodos: estudio retrospectivo de 93 pacientes diagnosticados de cáncer ovárico en estadio III entre 2006 y 2012. Fueron seleccionadas 52 (55'9%) enfermas que se beneficiaron de una citorreducción completa u óptima, estableciéndose dos grupos ante la ausencia o presencia de adenopatías retroperitoneales durante el diagnóstico preoperatorio, para contrastar los objetivos del estudio. Resultados: el análisis estadístico de variables clínicas e histopatológicas determinó relación de la prealbúmina (p = 0'027) y Ca 125 (p = 0'048) con el riesgo de infiltración nodal. No se apreció valor significativo en los parámetros relativos a la extensión peritoneal del cáncer. La linfadenectomía lumboaórtica mejoró la supervivencia libre de enfermedad (25'7 ± 21.4 vs 35'6 ± 22 meses) con relevancia estadística (p = 0'033) pero no presentó grandes variaciones en la supervivencia global (39'7 ± 20'1 vs 41'9 ± 20'8 meses). Conclusiones: un estado nutricional deteriorado y un Ca 125 elevado podrían ser factores predictivos de afectación ganglionar. La realización de una linfadenectomía lumboaórtica sistemática parece incrementar la supervivencia libre de enfermedad ante una citorreducción adecuada y ausencia de complicaciones postquirúrgicas graves. Se necesitará un mayor reclutamiento de pacientes para conocer con más exactitud el patrón de enfermedad ganglionar a efectos de una indicación de linfadenectomía más selectiva
Asunto(s)
Humanos , Femenino , Escisión del Ganglio Linfático/estadística & datos numéricos , Neoplasias Ováricas/cirugía , Ganglios Simpáticos/cirugía , Neoplasias Peritoneales/cirugía , Invasividad Neoplásica/patología , Metástasis Linfática/patología , Neoplasias Ováricas/patología , Ganglios Simpáticos/patología , Neoplasias Peritoneales/patología , PronósticoRESUMEN
The impact of upper thoracic percutaneous sympathectomy with radiofrequency on the quality of life (QOL) of patients with palmar hyperhidrosis was evaluated. Thirty-six patients with palmar hyperhidrosis were selected for a prospective observational study. Treatment consisted of percutaneous radiofrequency thoracic sympathectomy of T3 and T4 ganglions in all cases. QOL questionnaires were applied preoperatively, on the 1st postoperative (PO) day, and on the 30th, 90th, 180th, and 360th PO days. Furthermore, compensatory hyperhidrosis (HDSSc) scale measures were used simultaneously, in order to evaluate the rate and frequency of this side effect. The QOL questionnaire evaluation showed preoperative values of 83.94⯱â¯4.74 (meaning poor quality of life), decreasing to 24.61⯱â¯2.86 on the 1st PO day, 25.14⯱â¯3.12 on the 30th PO day, 31.28⯱â¯4.42 on the 90th PO day, 32.97⯱â¯4.54 on the 180th PO day, and 33.94⯱â¯4.6 on the 360th PO day (all postoperative results with values below 35 were considered optimal). Compensatory hyperhidrosis (HDSSc) scale values were 1.14⯱â¯0.35 on the 1st PO day, 1.42⯱â¯0.55 on the 30th PO day, 1.83⯱â¯0.85 on the 90th PO day, 1.92⯱â¯0.91 on the 180th PO day, and 1.92⯱â¯0.91 on the 360th PO day (meaning that hyperhidrosis was mainly unnoticed). Patients' subjective satisfaction was considered very good and the majority of patients would recommend the treatment procedure. Percutaneous radiofrequency thoracic sympathectomy had a positive impact on the quality of life of patients with palmar hyperhidrosis, compared to the surgical treatment, with a low rate and intensity of HDSSc and without other complications.
Asunto(s)
Ganglios Simpáticos/cirugía , Hiperhidrosis/cirugía , Ablación por Radiofrecuencia , Sudoración , Simpatectomía/métodos , Adolescente , Adulto , Femenino , Ganglios Simpáticos/diagnóstico por imagen , Ganglios Simpáticos/fisiopatología , Mano , Humanos , Hiperhidrosis/diagnóstico , Hiperhidrosis/fisiopatología , Masculino , Satisfacción del Paciente , Estudios Prospectivos , Calidad de Vida , Ablación por Radiofrecuencia/efectos adversos , Radiografía Intervencional , Simpatectomía/efectos adversos , Vértebras Torácicas , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Median Arcuate Ligament Syndrome (MALS) is a rare clinical condition. METHODS: Through the analysis of a case report and a review of the international literature, we examined whether robotic and laparoscopic MAL release are safe and feasible. RESULTS: Of 354 and 19 patients who underwent laparoscopic MAL release (LMALr) and robotic-assisted MAL release (RMALr), respectively, conversion to open surgery occurred in 6.8% of cases following LMALr, whereas no case of conversion was reported following RMALr. Immediate symptomatic improvement was reported in 92.1% of cases following LMALr and in 84.2% of cases following RMALr. In the LMALr group 9% of patients presented with recurrence of symptoms, whereas the percentage in the RMALr group was 5.3%. LMALr was related to a higher overall complication rate when compared with RMALr (7.3% vs 5.3%). CONCLUSIONS: Both laparoscopic and robotic-assisted MAL lysis with celiac ganglionectomy can be safely performed with minimal patient morbidity.