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PubMedDate not supplied

[Interventional radiology in the palliative treatment of pancreatic cancer].

AIMS AND BACKGROUND: Pancreatic carcinoma often involves the head of the pancreas and obstructive jaundice is its earliest sign. It sometimes extends to celiac plexus and duodenum causing pain and bowel obstruction respectively. Only 20% of cases are totally resectable (stage I) at the time of diagnosis. Palliative treatment is the only available therapeutic option when the tumor extends surrounding organs or has given lymphatic metastases (stage II, III, IV). The aim of this study is to evaluate effectiveness of interventional radiology procedures on unresectable cancer palliative treatment. METHODS: Between Jan 90 and Sep 98, 195 patients with unresectable pancreatic carcinoma received percutaneous treatments. They were 104 males and 91 females with mean age of 74 years (range, 48-95). One hundred eighty four patients underwent biliary drainage, six patients underwent celiac plexus block, two patients were treated by bowel stenting. Two patients received both biliary and bowel stents, one patient underwent biliary drainage and celiac plexus block. RESULTS: Jaundice treatment was performed by placement of drainage catheters in 48 patients, polymeric endoprostheses in 58 and metallic stents in 77 (67 Wallstents). Biliary drainage was successful in all cases obtaining appreciable bilirubin serum levels reduction and jaundice regression in 175 patients (95%). In 44 patients Wallstents were placed during a single PTC session time ("one step" technique). In 21 cases (11%) peri-procedural complications occurred. Follow-up related to 85 patients shows survival rate covered between 30 and 570 days (mean, 142). Best survival values occurred in patients who underwent "one step" technique. Celiac plexus block was successful in 5/7 cases (71%) with no complications, total pain relief and withdrawal of pharmacological treatment. Bowel stenting achieved complete recanalization of intestinal loop in 2 cases but showed troubles related to management of these patients. CONCLUSIONS: In patients with unresectable pancreatic carcinoma palliation is the only therapeutic option and has the purpose to achieve biliary tree decompression and eliminate jaundice associated symptoms, improving quality of life and reducing hospitalization. Jaundice relief is reachable by surgical, endoscopic or percutaneous approach. Surgical palliation is characterized by disadvantageous cost-effectiveness rate. Endoscopic and percutaneous palliations are alternative, although, in selected patients, percutaneous Wallstents placement by one step technique is perhaps the most successful procedure, showing high rate of technical outcome with low complications and short time spent in hospital. Celiac plexus block under CT guidance constitutes a reliable method for management of pain. At present bowel stricture treatment is surgical.

Abdominal Pain↗
PubMed1994

[CT-guided celiac ganglion block. The authors' own experience].

Celiac plexus neurolysis is considered an effective technique for relieving abdominal cancer pain. CT yields accurate anatomical detailing, thus allowing the indirect location of the celiac plexus and the planning of needle trajectory and positioning. September 1992 to December 1993, twenty-eight celiac plexus neurolyses for pain relief were performed in 26 patients (13 men and 13 women), 17 through the anterior and 11 through the posterior access. These patients had been referred to our department for pain management. Forty-eight hours after alcoholization, 20 patients (71%) had complete pain regression and their analgesic treatment was thus discontinued. 36% of the patients did not need any analgesics for 30 to 169 days. No neurologic complications were observed. Only transient orthostatic hypotension requiring no treatment developed in all our patients during the first 24 hours after the block. To conclude, we believe celiac plexus alcoholization under CT guidance to be a safe and effective technique for relieving abdominal pain due to cancer or benign conditions. We prefer the anterior approach because it is better accepted by the patients and more easily performed by the operators.

Abdominal Neoplasms↗
PubMed2003

Evaluation of a new curved linear array echoendoscopy system for EUS.

BACKGROUND: EUS-FNA can be used to accurately diagnose and stage GI and pulmonary neoplasms. This study evaluated the performance characteristics of a new compact linear EUS system during EUS-FNA. METHODS: A total of 37 patients enrolled in this prospective pilot study underwent clinically indicated EUS-FNA and/or celiac plexus neurolysis with the compact EUS system. RESULTS: The mean time to perform a radial and linear array EUS with FNA and/or celiac plexus neurolysis was 24 minutes shorter with the compact EUS system compared with that for an historical control procedure in which a conventional linear EUS unit was used (p = 0.0007). The EUS images and visualization of the needle during EUS-FNA were rated good to excellent in greater than 95% of the patients. With respect to ease of esophageal intubation, duodenal intubation, and general maneuverability, the performance of the new linear echoendoscope, compared with a radial scanning videoechoendoscope, was the same or better in, respectively, 85%, 87%, and 100% of procedures. The video image quality of the new linear array echoendoscope was superior to that of the radial scanning videoechoendoscope in all patients. No complications were encountered. CONCLUSIONS: EUS-FNA and celiac plexus neurolysis can be performed safely with the new compact EUS system. The efficiency of this procedure is enhanced compared with historical experience with other instruments. Although image quality is sufficient for EUS-FNA and celiac plexus neurolysis, the compact unit cannot be used as a "stand-alone" system for routine diagnostic EUS, and its use must be complemented by standard radial imaging.

Biopsy, Needle↗
PubMed1999

[Moderating action of celiac block in experimental pancreatitis in the dog].

BACKGROUND: Pancreatic ischemia seems to be responsible of transition from edematous to hemorrhagic forms in acute pancreatitis. (AP) Sympathetic system vasoconstriction, through celiac plexus play an important role in the pathogenesis of acute pancreatitis. OBJECTIVE: Determinate the effects of anesthetic celiac blockade in an experimental model of AP. METHODS: Distal pancreatectomy and intraductal injection of autologous bile in 28 mongrel dogs. Blockade of celiac plexus with bupivacaine in the experimental group B. Anatomopathologic examination after 72 hours. RESULTS: Experimental group B developed milder forms of AP, while the control group A developed severe forms. CONCLUSIONS: Results suggest that celiac plexus blockade with bupivacaine may prevent the development of necrohemorrhagic forms of PA in a canine model.

Acute Disease↗
PubMed1989

Management of pain in pancreatic cancer.

Potentially useful modalities of pain control in pancreatic cancer include antitumor therapy, pharmacotherapy, celiac plexus block, splanchnic nerve block, intercostal nerve block, and psychological intervention. These modalities are often used concurrently in treating the multiple dimensions that affect pain. Although thorough assessments are lacking, preliminary data suggest that antitumor chemotherapy and radiotherapy and celiac plexus block are especially useful modalities of pain control in these patients. The optimal time in the disease course for intervention with celiac plexus block is not known. Further studies are needed to clarify the nature of pain syndromes involved and the role of the various therapeutic modalities.

Analgesics↗
PubMed1989

[Significance of extensive surgery in pancreatic cancer].

The pancreas is located in the retroperitoneal space, and its anatomical position is very important in devising a rational surgical approach to pancreatic cancer. In cancer of the pancreas head, cancer cells could invade the portal vein and perineural space of the celiac plexus, and metastasize to regional lymph nodes around the celiac axis. For these reasons, we have performed on extensive operation for cancer of the pancreas head, in which a pancreaticoduodenectomy was performed with extensive resection of the regional lymph nodes around the celiac axis, resection of the celiac plexus and segmental resection of the portal vein. As a result, seven out of 31 resected cases survived more than 5 years after the operation. On the other hand, local recurrence was still found at autopsy in 11 of 12 patients who underwent the extensive operation and died of the recurrent disease. Therefore, further removal of adjacent tissues behind the pancreas and extensive dissection of the regional lymph nodes around the celiac axis seem important for improving the survival of patients with cancer of the pancreas head. Postoperatively, skillful management is also required for severe intestinal malabsorption and diabetic state following the operation.

Adult↗
PubMed1993

Celiac (solar) plexus syndrome. A frequently overlooked source of abdominal pain.

Of the nonorganic abdominal disorders the celiac/solar plexus syndrome represents a frequently seen entity characterized by the typical association of epigastric pain and "lambda-type" tenderness. It is a special type of abdominal neurosis in which the pain arises in the periaortic nervous plexuses. Its clinical importance is in the differential diagnosis, since it is often misinterpreted as a painful condition of abdominal or retroperitoneal origin.

Abdominal Pain↗
PubMed1983

Peripheral sympathetic pathways to gastroduodenal region of the guinea pig.

The sympathetic pathways to the stomach and duodenum of the guinea pig were studied by electrical nerve stimulation and by gastric distension in vitro and in vivo. The in vitro preparation consisted of the stomach and duodenum connected by para-arterial nerves to the celiac plexus. Gastroduodenal motility was measured with intraluminal pressure catheters. Stimulation of splanchnic nerves resulted in inhibition of propulsive contractions of both the stomach and duodenum. Stimulation of the left gastric nerve inhibited the stomach but not the duodenum, and stimulation of the gastroduodenal nerve inhibited the duodenum only. When the gastroduodenal nerve was stimulated, excitatory postsynaptic potentials were elicited in 18% of the cells from which intracellular recordings were made in the celiac ganglia. When the stomach was distended to a pressure of 5-7 cmH2O, propulsive contractions in the duodenum stopped in 86% of the distensions in the in vivo preparations and in 62% of the distensions in the in vitro preparations. Section of the gastroduodenal nerve eliminated the distension-induced inhibition of duodenal propulsion in vitro. These experiments describe the efferent sympathetic pathways to the celiac plexus of the guinea pig and demonstrate reflex pathways to the celiac plexus that can mediate a gastroduodenal inhibitory reflex.

Animals↗
PubMed1994

Altered reactivity of isolated segmental lumbar arteries of dogs following exposure to ethanol and phenol.

Celiac plexus neurolysis is a useful analgesic technique in patients with upper abdominal cancer. Although complications are infrequent, occasionally celiac neurolysis results in paraplegia. It is hypothesized that paraplegia after celiac neurolysis results from neurolytic drug-induced spasm of lumbar segmental arteries that perfuse the spinal cord, although no data are available to support or refute the idea. Whether drugs used for celiac plexus neurolysis alter the reactivity of dogs' lumbar segmental arteries was studied in vitro. Rings of lumbar segmental arteries, suspended in Krebs-Ringer solution in organ baths, were passively stretched to the optimal point on their length-tension curve. After a 45-min rest the responsiveness of each ring was established by adding an ED50 concentration of norepinephrine to the bath. Subsequently, Krebs-Ringer solution containing a single concentration of phenol or ethanol was added. Concentrations studied included 1%, 3%, 6%, 7%, 8%, 9%, and 12% phenol; and 3%, 6%, 10%, 25%, 50%, 75%, and 90% ethanol. The magnitude of the phenol-induced contractile response was directly related to concentration, with 8%, 9% and 12% phenol, producing sustained contractile responses compared to norepinephrine-induced control contractile responses. The ethanol-induced contractile response was inversely related to concentration. Ethanol (3% and 6%) produced sustained contractile responses compared to norepinephrine-induced control contractile responses. Studies were then done to further elucidate the agonist properties of phenol and ethanol. The contractions caused by ethanol or phenol did not appear to be mediated through adrenergic, opioid, muscarinic, or serotonin receptors or sodium channels.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

[The sources of the innervation of the sphincter of the esophagogastric junction in rats].

The investigation has been performed by means of the luminescent microscopical method. The retrograde axonal transport of the fluorescent marker primuline has demonstrated that a definite amount of labelled cells are observed in the celiac plexus, in nodes of the thoracic part of the sympathetic trunk (predominantly in Th6-Th8). Innervation of the EGP sphincter is mainly performed from the sympathetic trunk nodes (Th6-Th8) and from the celiac plexus.

Animals↗
PubMed1983

[Effect of periarterial sympathectomy and decompensation of the celiac trunk on gastric secretion in the abdominal pain syndrome].

The gastric secretion was investigated after periarterial sympathectomy and decompression of the celiac trunk in 50 patients. It was shown that basal and stimulated secretion was persistently increased in cases with intact structure of the celiac plexus, while in cases with degenerative changes with fibrosis of the ganglia and conductors the gastric secretion was not found to significantly change. The data obtained should be taken into consideration when operating upon the celiac artery and celiac plexus.

Abdomen↗
PubMed1985

Constitution of the greater splanchnic nerve in the rat.

The greater splanchnic nerve originating from the sympathetic ganglia between the 10th and 12th ribs on the dorsal thoracic wall passes through the diaphragm between its medial and lateral erura, to form the celiac plexus around the celiac trunk and superior mesenteric artery in the abdominal cavity. The nerve consists of about 10,000 of nerve fibers and of 25,000 of ganglion cells in its whole length of 2.5 cm; nerve fibers can be divided into myelinated fibers, accounting for less than 6% of total numbers, and unmyelinated fibers, which amount to more 90%. Special attention was not paid to the numerous ganglion cells in terms of their shapes, sizes, and cell organelles except for a small number of binucleate cells. However, the nerve contains remarkable synapses that connect between axon showing flat, elliptical, and cored vesicles and dendrite, between another type of axon having elliptical and cored vesicles and dendrite, and even between dendrite and cell body, in which synaptic vesicles are small spherical and elliptical. These facts can suggest that the greater splanchnic nerve contains more complex structure than has been hitherto described.

Animals↗
PubMed1983

[Perineural invasion of pancreas head carcinoma].

Perineural invasion of carcinoma is of considerable interest especially in the pancreas, because this organ is adjacent to the main autonomic plexuses of the abdomen. The present study was based upon 14 cases of primary carcinoma of the pancreas head in which total pancreatectomy with extensive dissection of the regional lymph nodes and autonomic plexuses was performed. Information concerning perineural invasion was obtained from histological specimens of the pancreas, lymph nodes and autonomic plexuses. Carcinomatous involvement of nerves was observed in all 14 cases within parenchyma of the pancreas head, but never found in the body and tail. Perineural extension of carcinoma to the regional autonomic plexuses was observed in 9 cases, which included the pancreatic capital plexus in 8 patients, superior mesenteric plexus in 3, celiac plexus in 2 and plexus on the common bile duct in 2 patients. This manner of invasion had no relationship with behaviour of lymph node metastasis. Thus, invasion and extension along the autonomic nerves by carcinoma of the pancreas were more common than usually recognized. Extensive dissection of the regional autonomic plexuses should be performed to increase the possibilities of a curative procedure.

Adenocarcinoma↗
PubMed2001

Origin of the thoracic duct and pancreaticoduodenal lymphatic pathways to the para-aortic lymph nodes.

We investigated the afferent and efferent connections of the para-aortic lymph nodes (group 16 nodes) relative to the origin of the thoracic duct in 85 postmortem cadavers. The origin was usually restricted to groups 16b1-inter and -latero nodes (type I; 90.6%), regardless of whether the union of their efferents occurred at the abdominal or thoracic level. We also occasionally observed thick collecting vessels originating from the dorsal aspect of the pancreaticoduodenal region, running along the right side of and superficial to the celiac plexus and emptying into group 16b1 nodes. The thoracic duct originated occasionally not only from group 16b1 nodes but also from group 16a2 nodes (type II; 9.4%). Moreover, in all 85 specimens, the group 16a2-inter node often received afferents from the celiac plexus itself or the tight connective tissue between the plexus and diaphragmatic crus, or both. The results support the reliability of the extended D2 lymphadenectomy (D2 + group 16b1 nodes + group 16a2-inter node) for curative cancer surgery in the pancreaticoduodenal region.

Aorta, Thoracic↗
PubMed1989

[Celiac neurolysis. Anterior approach and x-ray computed tomographic guidance: a simple and logical technic].

Two cases of celiac plexus neurolysis under CT guidance by an anterior approach are reported. This technique was performed on two patients who complained of epigastric pain due to a pancreatic carcinoma. Alcoholization was performed with 50 cc of a 50% solution of ethyl alcohol. The tip of the needle was located just above the origin of the coeliac axis in front of the aorta. In the two cases the block was successful, leading to suspension of morphine administration. Computed tomography scans after injection showed that the space of diffusion corresponds to the presumed location of the celiac plexus and confirms that the anterior approach is valid providing that a sufficient dose is injected. This technique, can be easily performed and deserves a more important place in the management of pancreatic pain.

Autonomic Nerve Block↗
PubMed1997

Effect and clinical value of splanchnic nerve block of hemodynamics in ACST.

The condition of acute cholangitis of severe type (ACST) develops very rapidly and the prognosis is poor. The main clinical feature is that there is an obvious dynamic variation, which is the principal factor for the early occurrence of shock and death. In this study the Japanese long ear rabbits were used and biliary tract pressure increasing and splanchnic nervous plexus blocking experiments were conducted. Our results indicate that 0.6% of lidocaine can be used to block the right celiac plexus. It can avoid the decrease of blood pressure due to the pressure increase of the biliary tract, and the decrease of blood pressure due to the pressure increase of the biliary tract can be corrected by local anesthesia. 8 cases in conformity with the ACST diagnostic standards received the right renal capsule block injection for the purpose of stopping the celiac plexus, 6 cases of whom had a return of blood pressure to various extent, suggesting that the splanchnic nervous activity in the occurrence of ACST is of great significance. The technique may provide a new approach for the clinical treatment of ACST.

Acute Disease↗
PubMed1989

Pain management of pancreatic carcinoma: a review.

This paper reviews the most commonly used pain management interventions with patients who have carcinoma of the pancreas. Prior research has focused on the use of celiac plexus block. Other methods such as pain medication as well as chemical and surgical splanchnicectomy are also reviewed. Results of this review point to very successful pain relief rates with celiac plexus block and the urgent need for vigorous evaluation studies of pain management techniques in patients with pancreatic carcinoma.

Analgesics↗
PubMedDate not supplied

[Transdiscal percutaneous approach of splanchnic nerves].

Neurolytic celiac plexus block is an established, well-developed procedure and the most accepted and applied in visceral pain; recognized by the WHO and the IASP, it is very good in palliative management of cancer pain in visceral of superior hemiabdomen. However, conventional techniques in celiac plexus have not been successful in patients with organomegaly and/or anatomic abnormalities, except when splanchnic nerve neurolytic blockade is used. On the other hand, conventional techniques in splanchnic nerves are highly associated with complications such as paraplegia, pneumothorax and liver or renal punction. For these reasons an alternative option has ben designed, termed transdiscal percutaneous approach of splanchnic nerves under tomographic control; this technique affords the option of improving accuracy and performance with minimum risks, particularly lung puncture and its consequences. Under this technique, 64 superior hemi-abdomen cancer patients initiated such a study (four without morphine treatment quit the study), 55% females and 45% males, visceral pain syndrome 65%, and mixed, 35%. Side effects were dyspnea 5%, hypotension 26.7%, nausea 31.7%, diarrhea 83.3% in which diarrhea means increased peristalsis showing adequate sympathetic inhibition via splanchnic nerves), vomiting 28.3%, punction-site pain 46.7%, aorta punction 6.7%, anal pleural punction 5%. All these incidents were dealt with by conservative treatment. Student t test showed that pain intensity in all measurements after procedure was different in comparison to basal pain intensity prior to procedure (p<0.05), emphasizing that at the 12th, 18th and 24th months, there was noticeable reduction in participants number with eight, five and four participants, respectively. Morphine intake at week 1, and 1, 2, 3, 6 and 12 months after procedure was different from basal intake prior to procedure (p<0.05) with same noticeable reduction in participant numbers at last stages. Butylhioscine intake at week 1, 1, 2, 3 and 6 months after procedure was different from basal intake prior to procedure (p<0.05). NSAIDs consumption was likely during 2 months after procedure (p<0.05). Linear regression showed that butylhioscine and morphine explained low percentage of pain intensity variance, controlling statistically that effect over pain. There were no differences in pain pathophysiology with regard to cancer type. Transdiscal percutaneous approach of splanchnic nerves guided by CAT is an alternative with minimal risks, as with lung punction, confirming that inhibiting splanchnic nerves has advantages in pain release, reducing and/or eliminating morphine consumption.

Abdominal Neoplasms↗