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Pelvic plexus contributes ganglion cells to the hindgut enteric nervous system.

The hindgut enteric nervous system (ENS) contains cells originating from vagal and sacral neural crest. In avians, the sacral crest gives rise to the nerve of Remak (NoR) and pelvic plexus. Whereas the NoR has been suggested to serve as the source of sacral crest-derived cells to the gut, the contribution of the pelvic ganglia is unknown. The purpose of this study was to test the hypothesis that the pelvic ganglia contribute ganglion cells to the hindgut ENS. We observed that the quail pelvic plexus develops from neural crest-derived cells that aggregate around the cloaca at embryonic day 5. Using chick-quail tissue recombinations, we found that hindgut grafts did not contain enteric ganglia unless the pelvic plexus was included. Neurofibers extended from the NoR into the intestine, but no ganglion cell contribution from the NoR was identified. These results demonstrate that the pelvic plexus, and not the NoR, serves as the staging area for sacral crest-derived cells to enter the avian hindgut, confirming the evolutionary conservation of this important embryologic process.

Animals↗

[Autonomic innervation of the female pelvis. Anatomic basis].

The pelvic plexus with its sympathetic (hypogastric nerves, sacral sympathetic trunk) and parasympathetic (pelvic splanchnic nerves) sources provides and distributes the autonomic nervous supply for the pelvic organs. This homogeneous autonomic nerve plate is located within and deeply to the peritoneal fold (recto-uterine in the female pelvis) lying medially to the internal iliac vessels. Autonomic nerve fibres emerge from the pelvic plexus and travel to the anterolateral aspect of the rectum and the inferolateral and posterolateral aspects of the bladder and female genital tract. In addition, pelvic organs are innervated by nerves accompanying the vessels and the ureter which penetrate the pelvic plexus. Knowledge of the topography of the pelvic plexus indicates the most common sites for iatrogenic lesions and should help us in avoiding postoperative autonomic dysfunction.

Autonomic Pathways↗

[Careful dissection of the pelvic plexus helps alleviate urinary retention following radical hysterectomy].

Radical hysterectomy remains to be the treatment of choice for carcinoma of the uterine cervix. As pelvic nerve plexuses are distributed in the operative field, damage to the plexuses is likely to occur, which is responsible for the post-operative atonia of the urinary bladder and urinary retention. To reduce the incidence of this postoperative complication, the composition and distribution of the pelvic nerve plexuses in relation to the utero-sacral ligament and cardinal ligament of the uterus and paravaginal tissues were carefully dissected on 11 adult female cadavers. Based on the anatomic study, due precautions were made to avoid damage to the pelvic nerve plexuses during pelvic dissection for radical hysterectomy. As a result, the duration of postoperative urinary retention was significantly reduced while the 5- and 10-year survival rates remained unchanged.

Adult↗

Histologic and embryologic studies on the innervation of the pelvic viscera in patients with Hirschsprung's disease.

On the specimens taken at autopsy from three newborns with Hirschsprung's disease and three newborns in the control group, the innervation of the pelvic organs was histologically studied. The authors found that all the pelvic organs, except for the rectum in patients with Hirschsprung's disease, preserved a completely normal innervation not only of pelvic autonomic nerve plexuses, but also of sensory nerves of spinal origin. Even in the wall of the aganglionic rectum, the extrinsic sympathetic as well as parasympathetic nerve fibers were preserved, which showed a marked proliferative change due to the absence of target nerve cells upon which they otherwise terminated. An additional embryologic study was performed upon 20 human embryos. The results revealed that the pelvic nerve plexuses were formed during the six to ten gestational week period by neural cells migrating along the pelvic visceral branches of sacral nerves, while none of these neural cells was found to enter the rectum. The enteric plexuses of the rectum were formed later by neural cells that migrated down along the alimentary tract in a craniocaudal manner. The two separate origins, the sacral for the pelvic nerve plexuses and the vagal for the enteric plexuses of the rectum, seem to be the reason why innervation of the genitourinary organs, which are located in front of the aganglionic rectum, is normal in those patients with Hirschsprung's disease.

Autonomic Nervous System↗

Meningitis-retention syndrome. An unrecognized clinical condition.

BACKGROUND: A combination of acute urinary retention and aseptic meningitis has not been well known. This combination can be referred to as meningitis-retention syndrome (MRS), when accompanied by no other abnormalities. OBJECTIVE: To describe the results of a uro-neurological assessment in our patients with MRS. METHODS: In three patients (two men, one woman; age, 34-68 years), we performed urodynamic studies and relevant imaging and neurophysiological tests, in addition to cerebrospinal fluid (CSF) examination. RESULTS: All three patients developed acute urinary retention along with headache, fever and stiff neck. None had obvious neurological abnormalities, other than a slightly brisk reflex in the lower extremities. One had previously experienced generalized erythematous eruptions, but none had pain, hypalgesia or skin eruptions in the sacral dermatomes suggestive of Elsberg syndrome (infectious sacral polyradiculitis; mostly genital herpes). Brain/spinal/lumbar plexus MRI scans and nerve conduction studies were normal. CSF examination showed mild mononuclear pleocytosis, increased protein content, and normal to mildly decreased glucose content in all patients; increased myelin basic protein suggestive of central nervous system demyelination in one; and increased viral titers in none. Urodynamic study revealed, during the voiding phase, an underactive detrusor in all patients and an unrelaxing sphincter in one. These clinical manifestations were ameliorated within 3 weeks. CONCLUSIONS: We reported three cases of MRS, a peculiar syndrome that could be regarded as a mild variant of acute disseminated encephalomyelitis (ADEM). Urinary retention might reflect acute shock phase of this disorder. Although MRS has a benign and self-remitting course, management of the acute urinary retention is necessary.

Adult↗

Morphology of the caudal spinal cord in Rana (Ranidae) and Xenopus (Pipidae) tadpoles.

Using a variety of neuroanatomical and histological techniques, we compare the spinal cord and peripheral nerve distribution in the tails of larvae from Xenopus laevis and three species of Rana. The relatively large, postsacral spinal cord of Xenopus contains abundant motoneurons and their axons. Spinal nerves exit from the spinal cord in a regular array, one nerve per myotome, from the cervical region to near the end of the tail. Somata of motoneurons innervating caudal myotomes are found along the entire length of the tail. In contrast, the caudal cord of Rana is reduced to a filum terminale consisting of little more than an ependymal tube; spinal nerves to all caudal myotomes leave the cord in the sacral region and reach their motor targets via a cauda equina and caudal plexus. Motoneuron cell bodies innervating caudal myotomes are found only in the sacral region. The Rana larval pattern is similar to that of adult frogs and mammals, whereas the Xenopus larval pattern is more like that of salamanders and reptiles. These gross neuroanatomical differences are not due to differences in the size or developmental stage of the tadpoles, but instead are associated with differences in the swimming behavior of the larvae. The presence of motoneurons in the caudal spinal cord of Xenopus may provide local intermyotomal control within the tail; the elongated topography of the cord appears to permit finer, rostral-to-caudal regulation of neuromuscular activity. The Rana spinal cord, on the other hand--with motoneurons clustered anteriorly--may produce concurrent firing of adjacent ipsilateral myotomes, but at the expense of fine intermyotomal regulation. The fact that nerves in the tail of Xenopus enter and exit from the spinal cord locally, as opposed to far anteriorly as in Rana, means that for tadpoles of the same size, reflex arc lengths are many times shorter in Xenopus.

Animals↗

The cerebrospinal venous system: anatomy, physiology, and clinical implications.

There is substantial anatomical and functional continuity between the veins, venous sinuses, and venous plexuses of the brain and the spine. The term "cerebrospinal venous system" (CSVS) is proposed to emphasize this continuity, which is further enhanced by the general lack of venous valves in this network. The first of the two main divisions of this system, the intracranial veins, includes the cortical veins, the dural sinuses, the cavernous sinuses, and the ophthalmic veins. The second main division, the vertebral venous system (VVS), includes the vertebral venous plexuses which course along the entire length of the spine. The intracranial veins richly anastomose with the VVS in the suboccipital region. Caudally, the CSVS freely communicates with the sacral and pelvic veins and the prostatic venous plexus. The CSVS constitutes a unique, large-capacity, valveless venous network in which flow is bidirectional. The CSVS plays important roles in the regulation of intracranial pressure with changes in posture, and in venous outflow from the brain. In addition, the CSVS provides a direct vascular route for the spread of tumor, infection, or emboli among its different components in either direction.

Brain↗

The sacral neural crest contributes neurons and glia to the post-umbilical gut: spatiotemporal analysis of the development of the enteric nervous system.

The majority of the enteric nervous system is derived from vagal neural crest cells (NCC), which migrate to the developing gut, proliferate, form plexuses and differentiate into neurons and glia. However, for some time, controversy has existed as to whether cells from the sacral region of the neural crest also contribute to the enteric nervous system. The aim of this study was to investigate the spatiotemporal migration of vagal and sacral NCC within the developing gut and to determine whether the sacral neural crest contributes neurons and glia to the ENS. We utilised quail-chick chimeric grafting in conjunction with antibody labelling to identify graft-derived cells, neurons and glia. We found that vagal NCC migrated ventrally within the embryo and accumulated in the caudal branchial arches before entering the pharyngeal region and colonising the entire length of the gut in a proximodistal direction. During migration, vagal crest cells followed different pathways depending on the region of the gut being colonised. In the pre-umbilical intestine, NCC were evenly distributed throughout the splanchnopleural mesenchyme while, in the post-umbilical intestine, they occurred adjacent to the serosal epithelium. Behind this migration front, NCC became organised into the presumptive Auerbach's and Meissner's plexuses situated on either side of the developing circular muscle layer. The colorectum was found to be colonised in a complex manner. Vagal NCC initially migrated within the submucosa, internal to the circular muscle layer, before migrating outwards, adjacent to blood vessels, towards the myenteric plexus region. In contrast, sacral NCC, which also formed the entire nerve of Remak, were primarily located in the presumptive myenteric plexus region and subsequently migrated inwards towards the submucosal ganglia. Although present throughout the post-umbilical gut, sacral NCC were most numerous in the distal colorectum where they constituted up to 17% of enteric neurons, as identified by double antibody labelling using the quail-cell-specific marker, QCPN and the neuron-specific marker, ANNA-1. Sacral NCC were also immunopositive for the glial-specific antibody, GFAP, thus demonstrating that this region of the neural crest contributes neurons and glia to the enteric nervous system.

Animals↗

Sympathetic activity in the recto-rectal reflex of the guinea pig.

In the guinea pig, defecation is controlled by the myenteric plexus, whose activity is modulated by the sacral spinal and supraspinal centers. The purpose of this study is to clarify the control of defecation reflex by sympathetic nerves. The propulsive contractions of the rectum produced by rectal distension (recto-rectal excitatory reflex response) were abolished after transection of the Th 13 and/or L 4 segment. This response was reproduced again after removal of the lumbar segments (L1--4), division of the lumbar dorsal roots (L1--4), the lumbar splanchnic nerves or lumbar colonic nerves (LCN). The frequency of efferent discharges of LCN was increased slightly by rectal distension and remarkably increased after Th 13 and/or L 4 transection. Thus, there occurs during the recto-rectal reflex not only mucosal intrinsic reflex and sacral excitatory reflex via the pelvic nerves but also a lumbar inhibitory reflex via the colonic nerves, whose center may be located in the upper lumbar segments. But, the activity of the inhibitory center was depressed by the supraspinal center, so that an excitatory reflex is produced more dominantly than an inhibitory one in normal animals. All these extrinsic reflexes coordinate the activity of the myenteric plexus in defecation reflex.

Action Potentials↗