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1.
Acta Cir Bras ; 34(9): e201900902, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31778524

RESUMO

PURPOSE: To investigate the role of vagus nerve activation in the protective effects of hypercapnia in ventilator-induced lung injury (VILI) rats. METHODS: Male Sprague-Dawley rats were randomized to either high-tidal volume or low-tidal volume ventilation (control) and monitored for 4h. The high-tidal volume group was further divided into either a vagotomy or sham-operated group and each surgery group was further divided into two subgroups: normocapnia and hypercapnia. Injuries were assessed hourly through hemodynamics, respiratory mechanics and gas exchange. Protein concentration, cell count and cytokines (TNF-α and IL-8) in bronchoalveolar lavage fluid (BALF), lung wet-to-dry weight and pathological changes were examined. Vagus nerve activity was recorded for 1h. RESULTS: Compared to the control group, injurious ventilation resulted in a decrease in PaO2/FiO2 and greater lung static compliance, MPO activity, enhanced BALF cytokines, protein concentration, cell count, and histology injury score. Conversely, hypercapnia significantly improved VILI by decreasing the above injury parameters. However, vagotomy abolished the protective effect of hypercapnia on VILI. In addition, hypercapnia enhanced efferent vagus nerve activity compared to normocapnia. CONCLUSION: These results indicate that the vagus nerve plays an important role in mediating the anti-inflammatory effect of hypercapnia on VILI.


Assuntos
Líquido da Lavagem Broncoalveolar/química , Hipercapnia , Nervo Vago/cirurgia , Lesão Pulmonar Induzida por Ventilação Mecânica/prevenção & controle , Animais , Citocinas/análise , Modelos Animais de Doenças , Interleucina-8/análise , Masculino , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Fator de Necrose Tumoral alfa/análise , Vagotomia
2.
World Neurosurg ; 131: 180-185, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31408750

RESUMO

BACKGROUND: Vagus nerve stimulation (VNS) has become an increasingly popular procedure for the treatment of epilepsy and depression. Significant complications or side effects associated with VNS surgery may result from either the inadvertent direct injury to the vagus nerve as part of the surgical approach, placement of the electrode, or the concomitant stimulation of vagal efferent fibers. To mitigate these effects, the recognition of anatomic variants that may place the nerve at increased risk is necessary. CASE DESCRIPTION: During microsurgical dissection of the carotid sheath for the implantation of a vagus nerve stimulator in a 17-year-old male patient with refractory epilepsy, additional nonidentified nerve tissue was found running parallel to the vagus nerve. These fibers were two thirds of the thickness of the vagus nerve and ran medial to it, from the most superior to the most inferior aspect of the carotid sheath dissection, found at a distance of at least 4 cm in a craniocaudal direction. This duplicated nerve did not appear to branch from the vagal trunk nor exit the sheath but rather paralleled the course of the vagus nerve. The parallel course and the proximity of the unidentified nerve make this structure likely to be a duplicated vagus nerve. CONCLUSIONS: This is the first reported case of cervical vagus nerve duplication presented in the literature. Surgeons performing VNS implantations should be cognizant of this potential anomaly in order to avoid inadvertent injury to the nerve.


Assuntos
Nervo Vago/anormalidades , Adolescente , Variação Anatômica , Epilepsia Resistente a Medicamentos/cirurgia , Humanos , Achados Incidentais , Masculino , Nervo Vago/cirurgia , Estimulação do Nervo Vago
3.
World Neurosurg ; 131: 191-193, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31394364

RESUMO

BACKGROUND: Vagus nerve stimulation is a palliative treatment for patients with refractory epilepsy; however, the misplacement of electrodes may cause complications and thus needs to be avoided. METHODS: We herein report an intraoperative monitoring technique to prevent the misplacement of electrodes. Endotracheal tube electrodes were inserted to record electromyographic activity from the vocal cords and identify the vagus nerve. Electromyography electrodes were placed on the sternomastoid muscle, sternohyoid muscle, geniohyoid muscle, and trapezius muscle to record muscle activities innervated by the ansa cervicalis. The vagus nerve and ansa cervicalis were electrically stimulated during surgery, and electromyography of the vocal cords and muscles innervated by the ansa cervicalis was recorded. The threshold of vagus nerve activation ranged between 0.05 and 0.75 mA. RESULTS: The vagus nerve was successfully identified and differentiated from the nerve root of the ansa cervicalis using this technique. CONCLUSIONS: Intraoperative monitoring of the vagus nerve and ansa cervicalis is useful for safe and effective vagus nerve stimulation.


Assuntos
Monitorização Neurofisiológica Intraoperatória , Estimulação do Nervo Vago , Adolescente , Adulto , Idoso , Criança , Epilepsia Resistente a Medicamentos/fisiopatologia , Epilepsia Resistente a Medicamentos/cirurgia , Estimulação Elétrica , Eletromiografia , Feminino , Humanos , Monitorização Neurofisiológica Intraoperatória/métodos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/fisiopatologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Nervo Vago/fisiopatologia , Nervo Vago/cirurgia , Estimulação do Nervo Vago/métodos , Prega Vocal/fisiopatologia , Adulto Jovem
4.
Nat Commun ; 10(1): 2717, 2019 06 20.
Artigo em Inglês | MEDLINE | ID: mdl-31222048

RESUMO

Hepatic steatosis develops when lipid influx and production exceed the liver's ability to utilize/export triglycerides. Obesity promotes steatosis and is characterized by leptin resistance. A role of leptin in hepatic lipid handling is highlighted by the observation that recombinant leptin reverses steatosis of hypoleptinemic patients with lipodystrophy by an unknown mechanism. Since leptin mainly functions via CNS signaling, we here examine in rats whether leptin regulates hepatic lipid flux via the brain in a series of stereotaxic infusion experiments. We demonstrate that brain leptin protects from steatosis by promoting hepatic triglyceride export and decreasing de novo lipogenesis independently of caloric intake. Leptin's anti-steatotic effects are generated in the dorsal vagal complex, require hepatic vagal innervation, and are preserved in high-fat-diet-fed rats when the blood brain barrier is bypassed. Thus, CNS leptin protects from ectopic lipid accumulation via a brain-vagus-liver axis and may be a therapeutic strategy to ameliorate obesity-related steatosis.


Assuntos
Leptina/metabolismo , Fígado/metabolismo , Bulbo/metabolismo , Hepatopatia Gordurosa não Alcoólica/patologia , Triglicerídeos/metabolismo , Animais , Barreira Hematoencefálica/metabolismo , Dieta Hiperlipídica/efeitos adversos , Modelos Animais de Doenças , Humanos , Infusões Intraventriculares , Injeções Intraventriculares , Leptina/administração & dosagem , Lipogênese/fisiologia , Lipoproteínas VLDL , Fígado/inervação , Masculino , Hepatopatia Gordurosa não Alcoólica/etiologia , Polietilenoglicóis/administração & dosagem , Ratos , Ratos Sprague-Dawley , Técnicas Estereotáxicas , Simpatectomia , Nervo Vago/fisiologia , Nervo Vago/cirurgia
5.
World Neurosurg ; 127: e809-e817, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30954756

RESUMO

OBJECTIVE: This 3-dimensional histologic study aimed to provide a precise description of the meningeal structures in the jugular foramen. METHODS: 22 posterior skull base tissue blocks containing the jugular foramen region were obtained from 11 human cadaveric heads. These blocks were plastinated and cut into serial sections. After staining, these sections were examined under an optical microscope and used to reconstruct a 3-dimensional visualization model. RESULTS: At the intracranial orifice of the jugular foramen, the meningeal dura formed 2 separate dural perforations: the glossopharyngeal meatus and the vagal meatus. The arachnoid extended into 2 dural meatuses and terminated at the inferior ganglion of the glossopharyngeal nerve in the glossopharyngeal meatus and the superior ganglion of the vagus nerve in the vagal meatus. At the intraforaminal part of the jugular foramen, the meningeal dura encased the glossopharyngeal nerve to form a dural sheath while encasing the vagus and accessory nerves to form a dural network. At the extracranial orifice of the jugular foramen, the dural wall of the jugular bulb extended downward to form a dense connective tissue sheath. The initial end of the internal jugular vein invaginated into this sheath and fused with the jugular bulb. CONCLUSIONS: Knowledge of the anatomy of the meningeal architecture of the jugular foramen can be helpful in avoiding surgical complications of the lower cranial nerves when this complex area is approached.


Assuntos
Nervo Glossofaríngeo/patologia , Meninges/patologia , Nervo Vago/patologia , Nervo Acessório/cirurgia , Idoso , Idoso de 80 Anos ou mais , Nervos Cranianos/patologia , Nervos Cranianos/cirurgia , Feminino , Nervo Glossofaríngeo/cirurgia , Humanos , Veias Jugulares/patologia , Veias Jugulares/cirurgia , Masculino , Bulbo/cirurgia , Meninges/cirurgia , Pessoa de Meia-Idade , Base do Crânio/patologia , Base do Crânio/cirurgia , Nervo Vago/cirurgia
6.
Seizure ; 69: 77-79, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30986721

RESUMO

PURPOSE: Vagus nerve stimulation (VNS) is well established in the treatment of epilepsy and disorders of depression. The prevalence of depression is high in patients with epilepsy, but still it remains unclear how patients with a comorbidity of epilepsy and symptoms of depression respond to VNS. METHODS: We investigated 59 patients with different subtypes of disorders of depression as a comorbidity of epilepsy, who underwent VNS-surgery. Before and one year after VNS surgery, the severity of symptoms of depression was evaluated by a psychiatrist using Montgomery-Åsberg Depression Rating Scale (MADRS) and Beck-Depressions-Inventory (BDI). Response towards epilepsy was measured by a seizure reduction of at least 50%. RESULTS: Symptoms of depression ameliorated in response to VNS in the overall of all patients MADRS 29 to 18 (p < 0,001) and BDI 24 to 14 (p < 0,001) and all subtypes of disorders of depression. Seizure reduction of at least 50% was achieved in two out of three of all patients two years after VNS. CONCLUSION: We were able to show the beneficial effect of VNS in the treatment of patients with pharmacoresistant epilepsy and a comorbidity of symptoms of depression.


Assuntos
Depressão/cirurgia , Epilepsia/cirurgia , Convulsões/cirurgia , Estimulação do Nervo Vago , Nervo Vago/cirurgia , Adolescente , Adulto , Transtorno Depressivo/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
9.
Neurochem Int ; 125: 47-56, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30738079

RESUMO

The mechanisms responsible for the anti-inflammatory effects of antidepressants are only partially understood. Published data indicate that the vagal anti-inflammatory pathway could be involved in mediating this effect. Therefore, we investigated the influence of subdiaphragmatic vagotomy on the anti-inflammatory effect of fluoxetine in rats injected with lipopolysaccharide (LPS) to induce an inflammatory response. The extent of this response was determined by measurement of TNF-α, IL-1ß, and IL-6 plasma levels, along with gene expression of TNF-α, IL-1ß, and IL-6 in the spleen and selected structures of the brain. To evaluate possible central mechanisms, c-fos mRNA levels were determined in the nucleus of the solitary tract, dorsal motor nucleus of the vagus, paraventricular hypothalamic nucleus, basolateral amygdala, central nucleus of the amygdala, hippocampus, and frontal cortex. We found that pretreatment with fluoxetine substantially prevented LPS-induced increases of pro-inflammatory cytokines in plasma and gene expression in the spleen and brain in animals with an intact vagus nerve. However, in vagotomized animals, fluoxetine pretreatment only partially attenuated the LPS-induced increase in these markers of peripheral inflammation. Our data has shown that fluoxetine exerts potent anti-inflammatory effects in both the periphery and brain. Moreover, we found that the peripheral anti-inflammatory action of fluoxetine is mediated, at least partially, by activation of a vagal anti-inflammatory pathway. The role of the vagus nerve in mediating the anti-inflammatory effects of antidepressants has been marginally explored and our findings highlight its potential contribution to this mechanism of action of antidepressants.


Assuntos
Anti-Inflamatórios/farmacologia , Antidepressivos/farmacologia , Fluoxetina/farmacologia , Mediadores da Inflamação/metabolismo , Nervo Vago/metabolismo , Animais , Vias Eferentes/efeitos dos fármacos , Vias Eferentes/metabolismo , Mediadores da Inflamação/antagonistas & inibidores , Masculino , Ratos , Ratos Sprague-Dawley , Vagotomia/tendências , Nervo Vago/efeitos dos fármacos , Nervo Vago/cirurgia
10.
Acta cir. bras ; 34(9): e201900902, 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1054698

RESUMO

Abstract Purpose: To investigate the role of vagus nerve activation in the protective effects of hypercapnia in ventilator-induced lung injury (VILI) rats. Methods: Male Sprague-Dawley rats were randomized to either high-tidal volume or low-tidal volume ventilation (control) and monitored for 4h. The high-tidal volume group was further divided into either a vagotomy or sham-operated group and each surgery group was further divided into two subgroups: normocapnia and hypercapnia. Injuries were assessed hourly through hemodynamics, respiratory mechanics and gas exchange. Protein concentration, cell count and cytokines (TNF-α and IL-8) in bronchoalveolar lavage fluid (BALF), lung wet-to-dry weight and pathological changes were examined. Vagus nerve activity was recorded for 1h. Results: Compared to the control group, injurious ventilation resulted in a decrease in PaO2/FiO2 and greater lung static compliance, MPO activity, enhanced BALF cytokines, protein concentration, cell count, and histology injury score. Conversely, hypercapnia significantly improved VILI by decreasing the above injury parameters. However, vagotomy abolished the protective effect of hypercapnia on VILI. In addition, hypercapnia enhanced efferent vagus nerve activity compared to normocapnia. Conclusion: These results indicate that the vagus nerve plays an important role in mediating the anti-inflammatory effect of hypercapnia on VILI.


Assuntos
Animais , Masculino , Ratos , Nervo Vago/cirurgia , Líquido da Lavagem Broncoalveolar/química , Lesão Pulmonar Induzida por Ventilação Mecânica/prevenção & controle , Hipercapnia , Vagotomia , Distribuição Aleatória , Citocinas/análise , Interleucina-8/análise , Fator de Necrose Tumoral alfa/análise , Ratos Sprague-Dawley , Modelos Animais de Doenças
11.
Nat Commun ; 9(1): 5300, 2018 12 13.
Artigo em Inglês | MEDLINE | ID: mdl-30546054

RESUMO

The liver possesses a high regenerative capacity. Liver regeneration is a compensatory response overcoming disturbances of whole-body homeostasis provoked by organ defects. Here we show that a vagus-macrophage-hepatocyte link regulates acute liver regeneration after liver injury and that this system is critical for promoting survival. Hepatic Foxm1 is rapidly upregulated after partial hepatectomy (PHx). Hepatic branch vagotomy (HV) suppresses this upregulation and hepatocyte proliferation, thereby increasing mortality. In addition, hepatic FoxM1 supplementation in vagotomized mice reverses the suppression of liver regeneration and blocks the increase in post-PHx mortality. Hepatic macrophage depletion suppresses both post-PHx Foxm1 upregulation and remnant liver regeneration, and increases mortality. Hepatic Il-6 rises rapidly after PHx and this is suppressed by HV, muscarinic blockade or resident macrophage depletion. Furthermore, IL-6 neutralization suppresses post-PHx Foxm1 upregulation and remnant liver regeneration. Collectively, vagal signal-mediated IL-6 production in hepatic macrophages upregulates hepatocyte FoxM1, leading to liver regeneration and assures survival.


Assuntos
Proteína Forkhead Box M1/metabolismo , Hepatócitos/metabolismo , Interleucina-6/metabolismo , Regeneração Hepática/fisiologia , Macrófagos/metabolismo , Nervo Vago/metabolismo , Animais , Proliferação de Células , Ativação Enzimática , Hepatectomia , Fígado/citologia , Fígado/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Antagonistas Muscarínicos/farmacologia , Transdução de Sinais/fisiologia , Nervo Vago/cirurgia
12.
Artigo em Inglês | MEDLINE | ID: mdl-30407759

RESUMO

Vagal-sparing esophagectomy allows for curative tumor resection with better functional outcome and reduced postoperative morbidity, and minimally invasive esophagectomy has the advantage of avoiding the morbidities associated with big thoracoabdominal incisions. The video tutorial demonstrates our technique of preserving both vagus nerves and their celiac and hepatic branches in the abdomen during the thoracoscopic and laparoscopic phases of minimally invasive esophagectomy, with 2-field lymphadenectomy, for esophageal carcinoma. Four ports are used for thoracoscopic mobilization of the esophagus. Both vagus nerves are identified, encircled and suspended with a vascular loop and carefully separated from the esophageal wall along its whole length from above downwards beginning with the left vagus nerve then the right one.  Five ports are used for laparoscopic gastric mobilization and preservation of the hepatic and celiac vagal branches. Care should be taken during ligation and division of the left gastric artery to avoid injury of the celiac branch of the vagus nerve. Resection of the common hepatic artery and left gastric artery group of lymph nodes is performed.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Excisão de Linfonodo/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Nervo Vago/cirurgia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/secundário , Neoplasias Esofágicas/patologia , Humanos , Linfonodos/patologia , Linfonodos/cirurgia , Masculino , Mediastino , Pessoa de Meia-Idade
14.
Turk Kardiyol Dern Ars ; 46(6): 494-500, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30204141

RESUMO

Increased parasympathetic tone may cause symptomatic functional atrioventricular block (AVB) and necessitate pacemaker implantation. In these patients, where there is no structural damage to the conduction system, removal of the vagal activity using radiofrequency ablation seems to be a theoretically rational approach. Several methods have been used to determine suitable areas for vagal ganglia ablation. The aim of this report was to describe a new method to detect parasympathetic innervation sites without the need to use additional equipment or extend procedure time. A 51-year-old man was referred to the clinic for implantation of a permanent pacemaker because of symptomatic second-degree AVB and recurrent syncope. The functional nature of the AVB and a supra-Hisian location were verified with standard electrocardiography, Holter recordings, atropine sulfate test, and a standard electrophysiological study. Using conventional recordings, the electrograms were divided into 3 subgroups and sites demonstrating a fractionated pattern were targeted. All of the fractionated electrogram sites considered suitable for usual ganglion settlement were ablated. Biatrial ablation was initiated from the left atrial side. During left atrial ablation, the intrinsic basic cycle length of sinus node accelerated to 800 milliseconds despite AVB persistence. Subsequently, 1:1 atrioventricular conduction was achieved when ablation was applied around the coronary sinus ostium. The patient was completely asymptomatic, experiencing no episodes of dizziness or syncope, and was taking no medications at the end of 9 months of follow-up. In conclusion, electroanatomically guided vagal ganglia ablation may be a good alternative to pacemaker implantation in well-selected patients with functional AVB.


Assuntos
Bloqueio Atrioventricular/diagnóstico , Nervo Vago/cirurgia , Bloqueio Atrioventricular/cirurgia , Ablação por Cateter , Diagnóstico Diferencial , Eletrocardiografia , Eletrocardiografia Ambulatorial , Humanos , Masculino , Pessoa de Meia-Idade , Marca-Passo Artificial
15.
Front Immunol ; 9: 2032, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30237803

RESUMO

Patients surviving a septic episode exhibit persistent immune impairment and increased mortality due to enhanced vulnerability to infections. In the present study, using the cecal ligation and puncture (CLP) model of polymicrobial sepsis, we addressed the hypothesis that altered vagus nerve activity contributes to immune impairment in sepsis survivors. CLP-surviving mice exhibited less TNFα in serum following administration of LPS, a surrogate for an infectious challenge, than control-operated (control) mice. To evaluate the role of the vagus nerve in the diminished response to LPS, mice were subjected to bilateral subdiaphragmatic vagotomy at 2 weeks post-CLP. CLP-surviving vagotomized mice exhibited increased serum and tissue TNFα levels in response to LPS-challenge compared to CLP-surviving, non-vagotomized mice. Moreover, vagus nerve stimulation in control mice diminished the LPS-induced TNFα responses while having no effect in CLP mice, suggesting constitutive activation of vagus nerve signaling in CLP-survivors. The percentage of splenic CD4+ ChAT-EGFP+ T cells that relay vagus signals to macrophages was increased in CLP-survivors compared to control mice, and vagotomy in CLP-survivors resulted in a reduced percentage of ChAT-EGFP+ cells. Moreover, CD4 knockout CLP-surviving mice exhibited an enhanced LPS-induced TNFα response compared to wild-type mice, supporting a functional role for CD4+ ChAT+ T cells in mediating inhibition of LPS-induced TNFα responses in CLP-survivors. Blockade of the cholinergic anti-inflammatory pathway with methyllcaconitine, an α7 nicotinic acetylcholine receptor antagonist, restored LPS-induced TNFα responses in CLP-survivors. Our study demonstrates that the vagus nerve is constitutively active in CLP-survivors and contributes to the immune impairment.


Assuntos
Linfócitos T CD4-Positivos/imunologia , Bactérias Gram-Negativas/fisiologia , Infecções por Bactérias Gram-Positivas/imunologia , Sepse/imunologia , Nervo Vago/fisiologia , Animais , Ceco/cirurgia , Modelos Animais de Doenças , Infecções por Bactérias Gram-Positivas/metabolismo , Humanos , Tolerância Imunológica , Lipopolissacarídeos/imunologia , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , Camundongos Knockout , Sepse/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , Nervo Vago/cirurgia , Receptor Nicotínico de Acetilcolina alfa7/metabolismo
16.
Int J Pediatr Otorhinolaryngol ; 114: 9-14, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30262374

RESUMO

Schwannomas arising from the vagus nerve are extremely rare in children, with only 15 cases reported in the world literature. We describe a pediatric case of cervical vagal nerve schwannoma successfully treated with cranial nerve-sparing surgery. Our patient presented extensive mass in the right side of the neck with ipsilateral Horner's syndrome. Her first sign, anisocoria, was diagnosed at the age of 1.5 y, making her the youngest vagal schwannoma case ever reported. Using an ultrasonic surgical aspirator and nerve monitoring, a multidisciplinary team successfully removed the mass with no recurrence after 2 years of follow-up.


Assuntos
Neoplasias dos Nervos Cranianos/diagnóstico , Neurilemoma/diagnóstico , Doenças do Nervo Vago/diagnóstico , Criança , Pré-Escolar , Neoplasias dos Nervos Cranianos/cirurgia , Feminino , Síndrome de Horner/etiologia , Humanos , Lactente , Imagem por Ressonância Magnética , Pescoço , Neurilemoma/cirurgia , Nervo Vago/patologia , Nervo Vago/cirurgia , Doenças do Nervo Vago/cirurgia
17.
J Clin Neurosci ; 54: 161-164, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29908719

RESUMO

Cervical vagus nerve schwannoma is rare and its surgical procedure is controversial. The tumor is in general benign and slowly growing without causing symptoms, and therefore it should be advised to remove the tumor while preserving neural function. We operated on two patients with cervical vagus nerve schwannoma with the inter-capsular resection technique proposed by Hashimoto et al. without causing neurological deficits. It is the first time that the plane between the tumor-complex capsule layer (epineurium and perineurium) and true tumor capsule layer was histopathologically proved in this paper. The true tumor capsule layer contained no normal neural fibers, tumor tissues and neural sheath. The inter-capsular resection technique is a safe and reliable method for removing cervical vagus nerve schwannoma.


Assuntos
Neoplasias dos Nervos Cranianos/cirurgia , Neurilemoma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Nervo Vago/patologia , Nervo Vago/cirurgia , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Pescoço/patologia
18.
Curr Obes Rep ; 7(2): 162-171, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29667157

RESUMO

PURPOSE OF REVIEW: In this review, we describe the FDA-approved and investigational devices and endoscopic bariatric therapies for the treatment of obesity. We focus on literature published in the past few years and present mechanisms of action as well as efficacy and safety data. RECENT FINDINGS: Devices and endoscopic procedures are emerging options to fill the significant treatment gap in the management of obesity. Not only are these devices and procedures minimally invasive and reversible, but they are potentially more effective than antiobesity medications, often safer for poor surgical candidates and possibly less expensive than bariatric surgery. As many patients require a variety of management strategies (medications, devices, procedures, and/or surgery) in addition to lifestyle modifications to achieve clinically significant weight loss, the future of obesity treatment involves a multidisciplinary approach. Combinations of advanced treatment strategies can lead to additive or synergistic weight loss. This is an area that requires further investigation.


Assuntos
Medicina Bariátrica/instrumentação , Cirurgia Bariátrica/métodos , Endoscopia/métodos , Obesidade Mórbida/cirurgia , Medicina Bariátrica/tendências , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/instrumentação , Cirurgia Bariátrica/tendências , Aprovação de Equipamentos , Endoscopia/efeitos adversos , Endoscopia/instrumentação , Endoscopia/tendências , Humanos , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/instrumentação , Bloqueio Nervoso/métodos , Bloqueio Nervoso/tendências , Manejo da Obesidade/tendências , Obesidade Mórbida/fisiopatologia , Obesidade Mórbida/terapia , Estados Unidos , United States Food and Drug Administration , Nervo Vago/fisiopatologia , Nervo Vago/cirurgia
19.
World Neurosurg ; 115: 101-104, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29654959

RESUMO

BACKGROUND: Glossopharyngeal schwannomas are rare tumors. Clinical and radiologic presentation closely resembles those of vestibular schwannomas. Their clinical presentation varies from vestibulocochlear dysfunction to glossopharyngeal and vagal nerve dysfunction. CASE DESCRIPTION: We report a case of a small glossopharyngeal schwannoma presenting with intractable recurrent sudden episodes of vomiting that subsided after tumor resection. To our knowledge, this is the only case in the literature of glossopharyngeal schwannoma presenting with nerve irritation in the form of intractable emesis. CONCLUSIONS: Small glossopharyngeal schwannomas can present with irritative symptoms of the ninth cranial nerve causing vomiting refractory to medical treatment. Intracranial imaging should be considered in the investigation of unexplained intractable vomiting even if the gross neurologic examination is normal.


Assuntos
Neoplasias dos Nervos Cranianos/cirurgia , Doenças do Nervo Glossofaríngeo/cirurgia , Neurilemoma/cirurgia , Nervo Vago/cirurgia , Vômito/fisiopatologia , Neoplasias dos Nervos Cranianos/diagnóstico , Doenças do Nervo Glossofaríngeo/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Neurilemoma/diagnóstico , Resultado do Tratamento , Nervo Vago/patologia , Vômito/diagnóstico
20.
Int J Mol Sci ; 19(2)2018 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-29389905

RESUMO

Acetylcholine is the main transmitter of the parasympathetic vagus nerve. According to the cholinergic anti-inflammatory pathway (CAP) concept, acetylcholine has been shown to be important for signal transmission within the immune system and also for a variety of other functions throughout the organism. The spleen is thought to play an important role in regulating the CAP. In contrast, the existence of a "non-neuronal cardiac cholinergic system" that influences cardiac innervation during inflammation has been hypothesized, with recent publications introducing the heart instead of the spleen as a possible interface between the immune and nervous systems. To prove this hypothesis, we investigated whether selectively disrupting vagal stimulation of the right ventricle plays an important role in rat CAP regulation during endotoxemia. We performed a selective resection of the right cardiac branch of the Nervus vagus (VGX) with a corresponding sham resection in vehicle-injected and endotoxemic rats. Rats were injected with lipopolysaccharide (LPS, 1 mg/kg body weight, intravenously) and observed for 4 h. Intraoperative blood gas analysis was performed, and hemodynamic parameters were assessed using a left ventricular pressure-volume catheter. Rat hearts and blood were collected, and the expression and concentration of proinflammatory cytokines using quantitative reverse transcription polymerase chain reaction and enzyme-linked immunosorbent assay were measured, respectively. Four hours after injection, LPS induced a marked deterioration in rat blood gas parameters such as pH value, potassium, base excess, glucose, and lactate. The mean arterial blood pressure and the end-diastolic volume had decreased significantly. Further, significant increases in blood cholinesterases and in proinflammatory (IL-1ß, IL-6, TNF-α) cytokine concentration and gene expression were obtained. Right cardiac vagus nerve resection (VGX) led to a marked decrease in heart acetylcholine concentration and an increase in cardiac acetylcholinesterase activity. Without LPS, VGX changed rat hemodynamic parameters, including heart frequency, cardiac output, and end-diastolic volume. In contrast, VGX during endotoxemia did not significantly change the concentration and expression of proinflammatory cytokines in the heart. In conclusion we demonstrate that right cardiac vagal innervation regulates cardiac acetylcholine content but neither improves nor worsens systemic inflammation.


Assuntos
Acetilcolina/metabolismo , Endotoxemia/metabolismo , Coração/inervação , Inflamação/metabolismo , Nervo Vago/metabolismo , Animais , Pressão Sanguínea , Citocinas/genética , Citocinas/metabolismo , Endotoxemia/induzido quimicamente , Endotoxemia/fisiopatologia , Expressão Gênica , Coração/fisiopatologia , Hemodinâmica , Inflamação/fisiopatologia , Lipopolissacarídeos , Masculino , Miocárdio/metabolismo , Ratos Wistar , Nervo Vago/fisiopatologia , Nervo Vago/cirurgia
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