PubMed · 7952789
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T Diamond. Operative viva E.. https://pubmed.ncbi.nlm.nih.gov/7952789/
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The rectum and mesorectum are enclosed in a fascial sheath, the fascia propria, and represent an anatomical entity of abdominal origin. This package is a well-known anatomical and oncological base for radical rectal cancer excision. It is at present under discussion again under new aspects: The surgical and oncological quality of rectal cancer excision is largely surgeon-dependent. Modern rectal surgery is refined, with sharp, very precise dissection respecting the relevant fascial planes, identifying and protecting the autonomous pelvic nerves and achieving radical locoregional tumor clearance, thus virtually eliminating the serious problem of pelvic recurrence. In this overview the concept of total mesorectal excision (TME) is explained and open questions are discussed. It remains to be determined whether a refined and anatomically precise operative technique or the oncologic concept of TME are of primary importance, and also whether patient selection influences the results to some degree.
OBJECTIVE: To determine if exposure to electromagnetic fields influences regeneration of the transected facial nerve in the rat. DESIGN AND METHODS: The left facial nerve was transected in the tympanic section of the fallopian canal in 24 rats randomly assigned to 2 groups. The cut ends of the facial nerve were reapproximated without sutures within the fallopian canal to maximize the potential for regeneration. Rats in the experimental group (n= 12) were then exposed to pulsed electromagnetic stimulation (0.4 millitesla at 120 Hz) for 4 hours per day, 5 days per week, for 8 weeks. Rats in the control group (n=12) were handled in an identical manner without pulsed electromagnetic stimulation. Four other rats were given sham operations in which all surgical procedures were carried out except for the actual nerve transection. Two of these rats were placed in each group. Nerve regeneration was evaluated using electroneurography (compound action potentials), force of whisker and eyelid movements, and voluntary facial movements before and at 2-week intervals after transection. Histological evaluation was performed at 10 weeks after transection. Each dependent variable was analyzed using a 2-way analysis of variance with 1 between variable (groups) and 1 within repeated measures variable (days after transection). RESULTS: Statistical analysis indicated that N1 (the negative deflection of depolarization phase of the muscle and/or nerve fibers) area, N1 amplitude, and N1 duration, as well as absolute amplitude of the compound action potentials, were all significantly greater 2 weeks after transection in the experimental than in the control group of rats. The force of eye and whisker movements after electrical stimulation was statistically greater in the experimental group of rats 4 weeks after transection. Voluntary eye movements in the experimental group were significantly better at 5 and 10 weeks, while whisker movements were better at 3 and 10 weeks. There was no statistical difference between the 2 groups for any histological variable. CONCLUSION: Results of this study indicate that pulsed electromagnetic stimulation enhances early regeneration of the transected facial nerve in rats.
BACKGROUND: Successful restoration of laryngeal abductor function, using the phrenic nerve, has been described in the cat model in the acute phase. However, in clinical practice there is usually a considerable delay between injury to the RLN and presentation for treatment. Delayed reinnervation therefore would be more suitable in clinical practice. OBJECTIVE: To test the feasibility of delayed selective abductor reinnervation following transection of the recurrent laryngeal nerve (RLN). MATERIALS AND METHODS: In 12 cats, the right RLN was severed. Nine months later, the phrenic nerve was anastomosed to the distal RLN stump with all its branches directed toward the posterior cricoarytenoid muscle. For 10 weeks after the reconstruction, electromyography and videolaryngoscopy were performed weekly. Finally, histological analysis of the RLN was performed. RESULTS: Evaluation was possible in 11 cats. Reinnervation of the right posterior cricoarytenoid muscle with the phrenic nerve occurred in 10 cats following nerve anastomosis, but results of videolaryngoscopy showed adequate to good abduction in only 4 cats. The main limiting factor was reduced mobility of the cricoarytenoid joint. Evidence of spontaneous subclinical reinnervation after the delay was observed in 7 cats but apparently did not impede the surgical reinnervation. CONCLUSIONS: Delayed selective laryngeal abductor reinnervation was feasible, but function recovery was less successful than if performed immediately. Future investigations should concentrate on early determinants of spontaneous restoration of function to allow early selection of patients who are eligible for reinnervation surgery.