RESUMO
The study included 107 patients with distal lesions of limb arteries treated with the use of thoracoscopic sympathectomy. The best results in the early postoperative period were obtained in patients with Raynaud's disease. Modifications introduced into the methods of its treatment permitted to retain effectiveness of sympathectomy till the late postoperative period in 90% of the patients. Surgery for obliterative endarteritis and atherosclerosis was viewed as a possibility to preserve the supporting function of the limb. This purpose was attained in 73.2 and 62.5% of the patients respectively in the early and in 62 and 25% in the late postoperative periods.
Assuntos
Arteriosclerose Obliterante/cirurgia , Endarterite/cirurgia , Doença de Raynaud/cirurgia , Simpatectomia , Toracoscopia/métodos , Arteriosclerose Obliterante/diagnóstico , Arteriosclerose Obliterante/etiologia , Arteriosclerose Obliterante/fisiopatologia , Endarterite/diagnóstico , Endarterite/etiologia , Endarterite/fisiopatologia , Extremidades/irrigação sanguínea , Ganglionectomia/efeitos adversos , Ganglionectomia/normas , Humanos , Doença de Raynaud/diagnóstico , Doença de Raynaud/fisiopatologia , Fatores de Risco , Prevenção Secundária , Simpatectomia/efeitos adversos , Simpatectomia/métodos , Simpatectomia/normas , Nervos Torácicos/cirurgia , Tempo , Estimulação Elétrica Nervosa Transcutânea , Resultado do TratamentoRESUMO
Superior cervical ganglionectomy (SCGx) is a valuable microsurgical model to study the role of the sympathetic nervous system in a vast array of physiological and pathological processes, including homeostatic regulation, circadian biology and the dynamics of neuronal dysfunction and recovery after injury. Despite having several experimental applications in the rat, a thorough description of a standardized procedure has never been published. Here, we provide a brief review of the principal features and experimental uses of the SCGx, the surgical anatomy of the neck and sympathetic cervical chain, and a step-by-step description of how to consistently remove the superior cervical ganglia through the omohyoid muscle or the carotid triangle. Furthermore, we suggest procedures and precautions to be taken during and after surgery to optimize results and describe tools to validate surgical success. We expect that the following standardized and optimized protocol will allow researchers to organize knowledge into a cohesive framework in those areas where the SCGx is applied.
Assuntos
Ganglionectomia/métodos , Ganglionectomia/normas , Gânglio Cervical Superior/cirurgia , Animais , Modelos Animais de Doenças , Feminino , Síndrome de Horner/cirurgia , Masculino , Pescoço/anatomia & histologia , Pescoço/cirurgia , Proteínas de Neurofilamentos/metabolismo , Ratos , Ratos Wistar , Gânglio Cervical Superior/metabolismoRESUMO
Selective posterior lumbar rhizotomy has recently become an alternative method for relieving spasticity in patients with spastic cerebral palsy. This procedure involves the selective sectioning of the lumbosacral posterior nerve rootlets. Because the whole nerve root is not cut, tactile and proprioceptive sensation remain intact. The present study measured the changes that occurred in 29 patients with spastic cerebral palsy 2 days before surgery and from 4 to 14 months after surgery. Each patient was used as his or her own control. In addition to the clinical evaluation of function, gait was analyzed on appropriate patients with a simple digital camera and microcomputer. The results indicated positive gains after rhizotomy. These gains were, however, dependent on the patients' abilities before surgery. The most significant improvement occurred in thigh and knee ranges of movement. This somewhat controversial new method of treating spasticity shows promise in improving the quality of life of patients with spastic cerebral palsy and in facilitating their treatment.
