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At least 289 records · Page 16Linked to original sources
PubMed2002

Focal pancreatic hemorrhage mimicking pancreas carcinoma with lymph node metastasis.

A 67-year-old man was referred to our department because of a mass in the pancreas tail. Pancreatic tail cancer with lymph node metastasis was diagnosed, based on various radiological findings. Computed tomography (CT) revealed a slightly enhanced tumor mass around the celiac plexus, and endoscopic retrograde pancreatography (ERP) showed complete obstruction of the main pancreatic duct at the tail, although magnetic resonance imaging (MRI) demonstrated no elevation of the mean pixel value of the tumor after gadolinium (Gd) injection, and tumor markers of pancreas cancer were within normal limits. At surgery, the mass around the celiac plexus was found to be blood coagulation, and the pancreas tail tumor was found to be a focal hematoma in the pancreas. Pathologically, the hematoma was not encapsulated, and it was diagnosed as hemorrhage in the pancreas parenchyma. Both hemorrhagic lesions were suspected to have developed respectively. It is difficult to distinguish pancreas hemorrhage from carcinoma in the pancreas with chronic pancreatitis, especially when the hemorrhage is small in size and there are other extrapancreatic hemorrhagic lesions. For such diagnosis, the superiority of MRI with Gd injection is indicated.

Aged↗
PubMed2002

Chronic pancreatitis.

The pathogenesis of idiopathic chronic pancreatitis remains poorly understood despite the high expectations for ascribing the pancreatic damage in affected patients to genetic defects. Neither mutations in the cationic trypsinogen gene nor mutations of the cystic fibrosis conductance regulator gene account for the chronic pancreatitis noted in most patients with idiopathic chronic pancreatitis. Attempts to find an autoimmune basis for the pancreatitis in these patients have not been very successful. The diagnosis of small duct idiopathic chronic pancreatitis remains a great source of frustration for clinicians. Such patients with negative results of radiographic studies often cannot be diagnosed unless a hormone stimulation test such as a secretin test is performed. Although the porcine biologic form of secretin, which has been used to diagnose chronic pancreatitis, became unavailable because of widespread use in the treatment of children with autism, a synthetic form of porcine secretin has now been approved by the US Food and Drug Administration and is available. The true value of endoscopic ultrasonography in diagnosing small duct chronic pancreatitis remains to be fully defined. Endoscopic ultrasonography is becoming the test of choice in detecting radiographic abnormalities in both the parenchyma and ducts of the pancreas. Endoscopic ultrasonography-guided celiac plexus block can be performed relatively easily and very safely. It can provide excellent short-term pain relief in some patients, but reliable predictors of which patients will be successful with this therapy are not yet available. Because long-term follow-up data on the use of endoscopic ultrasonography in this respect are not available, and because the pain of chronic pancreatitis is, indeed, chronic, the role of endoscopic ultrasonography-guided celiac plexus block should be limited to treating those patients with chronic pancreatitis whose pain has not responded to other modalities.

Journal Article↗
PubMed2003

Sympathetic blockade in a canine model of gram-negative bacterial peritonitis.

We investigated, in a well-established canine model of human sepsis, the effects of two different techniques of sympathetic blockade during bacterial peritonitis on pain relief, hemodynamics, and survival rate. Twenty-two purpose-bred beagles (12-28 months old, weighing 10-12 kg) were studied. Fourteen animals received an epidural infusion of bupivicaine and morphine, and the other eight received either a celiac plexus block (n = 4) or a sham block (n = 4). Eighteen of the 22 animals received an intraperitoneal challenge of Escherichia coli (1-10 x 10(9) CFU kg(-1) body weight). At comparable doses of intraperitoneal-implanted E. coli (2.5-5 x 10(9) CFU kg(-1) body weight), the addition of sympathetic blockade produced a synergistic decrease in survival times (P = 0.002) and mean left ventricular ejection fraction (P = 0.008), and increase in creatinine levels (P = 0.02). There was also a significant increase in tumor necrosis factor (TNF) levels (P = 0.004) and decrease in blood endotoxin clearance (P = 0.006) associated with sympathetic blockade during sepsis. The celiac plexus-blocked animals had no improvement in pain scores, and subjectively looked clinically worse than animals with sepsis without a celiac plexus block. In contrast, the epidural block was effective in blocking the pain and discomfort associated with low lethality doses of intraperitoneal bacteria reflected by no increase in pain scores compared with animals not receiving bacterial challenge. This study shows that during severe bacterial peritonitis, maintenance of sympathetic tone irrespective of pain relief provided is necessary for clearance of bacterial toxins, control of proinflammatory mediator release, hemodynamic stability, and survival.

Animals↗
PubMed1991

[Extra-organic sources of innervation of the sigmoid].

By means of horseradish peroxidase administration into the wall of the sigmoid colon central part, localization, relative amount, body forms and size of the neurons, dealing with innervation of the given part of the colon have been determined. Labelled neurons are present in the colon wall, in ganglia of the caudal mesenteric artery nervous plexus, in the caudal and cranial mesenteric ganglia in the celiac plexus ganglia, in nodes and internodal branches of the lumbar part of the sympathetic trunk (the left one predominantly) and in the spinal ganglia from TXIII up to LVII. In the grey substance of the spinal cord labelled neurons are not revealed. The main part of the postganglionar sympathetic neurons, projecting their axons to the sigmoid colon, are situated in the caudal mesenteric ganglion. In the spinal ganglia the most part of the labelled neurons are to the left at the level of LII-LVI, to the right--at the level of LII-LV. The optimal time for revealing the greatest number of the labelled neurons are the 1st-3d days after administration of the enzyme. Capture of the lable takes place later in the neurons of those ganglia, which are situated more further from the place of peroxidase administration.

Animals↗
PubMed1988

The roots of the splanchnic nerves of the rabbit.

The aim of this study was to skeletonize the roots of the greater splanchnic nerve, lesser splanchnic nerve and lumbar splanchnic nerves as well as to investigate their participation in the structure of the celiac plexus in the rabbit.

Animals↗
PubMed2004

[Laparoscopic surgery of pancreas].

UNLABELLED: In pancreatic diseases, laparoscopic surgery is used to drain fluid collections in infected pancreatic necrosis, abscesses and pseudocysts, for cancer staging, to resect both benign and malignant tumors and for palliative procedures as well. In patients with intractable pain, percutaneous or surgical celiac plexus block can be performed, celiac ganglion alcoholization and torachoscopic splacnicectomy can be done. The laparoscopic approach for staging, allows us to identify very small peritoneal or hepatic metastasis, local invasion or deep hepatic metastasis. The lack of tactile sensation is a disadvantage in the laparoscopic procedures for both staging and resection; which can be compensated utilizing laparoscopic ultrasound. The laparoscopic pancreatic approach for resection is useful to treat neuroendocrine tumors, chronic pancreatitis and cystic neoplasm allowing preservation of the splenic vessels and the spleen. The insulinoma is a treatable laparoscopic tumor given its unique characteristics. The preoperative diagnosis is made by image studies like ultrasound, CAT scans, angiography studies, MRI, endoscopic ultrasound and calcium stimulation test. There are three surgical options: enucleation, distal pancreatectomy with or without preserving the spleen. The most important complication is the pancreatic fistula. CONCLUSIONS: The laparoscopic approach in pancreatic surgery is a feasible and safe one, although, its superiority over the classic open approach has not been demonstrated yet.

Adolescent↗
PubMed1994

Pancreatitis pain treatment: an overview.

Pain associated with chronic pancreatitis in particular is one of the most difficult and challenging syndromes that are presented to pain centers. Narcotic addiction is a common feature in this population. In this contribution an overview will be provided of the most pain treatment modalities based upon recent developments in the field of physiopathology, surgery, medical imaging and locoregional anesthetic techniques. Based upon personal experience it becomes progressively more clear that the most efficient alternative is not offered via neurolysis of the coeliac plexus. A shortlasting cure of 7-10 days with local anesthetics, injected via a coeliac plexus- or interpleural catheter may offer comparable but better reproducible durations of analgesia. Addition of corticosteroids during celiac plexus anesthesia may have additional benefits. Despite the progress in the field of internal medicine and surgery, a permanent solution is still far away for these patients.

Acute Disease↗
PubMed1981

[Sympathectomy and decompression of the celiac trunk in combination with proximal selective vagotomy in surgical treatment of duodenal ulcer complications].

The article describes 20 patients with complicated duodenal ulcers and 50 patients with chronic abdominal pain syndrome who had inflammatory-sclerotic alterations of elements of the celiac plexus and the arcuate ligament of the diaphragm accompanied in certain cases by compression stenosis of the celiac trunk. Patients with duodenal ulcers were subjected to desympathization and decompression of the celiac trunk in combination with proximal selective vagotomy and drainage of the stomach in cases of stenosis. The postoperative period was found to be favourable, without disturbed gastric evacuation. Good remote results were observed in 8 patients within one year and in 4 patients within 2 years after the operation.

Celiac Plexus↗
PubMed2005

[Aneurysms of the pancreaticoduodenal artery in association with stenosis or occlusion of the celiac trunk].

On the basis of an analysis of 69 patients including 2 personal observations the authors discuss the questions of pathogenesis, clinical picture, diagnosis and treatment of aneurysms of the pancreaticoduodenal artery in association with stenosis or occlusion of the celiac trunk (CT). A description of 2 cases with a true not broken aneurysms of the inferior pancreaticoduodenal artery and subocclusion of the celiac trunk is given which was caused by compression of the latter by the median arcuate ligament of the diaphragm and neurofibrous tissue of the celiac plexus. These patients were detected as a result of examinations and operative treatment of 556 patients with compressive stenosis of the celiac trunk for the period from 1982 through 2002. In one case a transcatheter embolization of the aneurysm was fulfilled followed in 3 months by a compression of the celiac trunk, in the other case a compression of the celiac trunk was made first and then in 5 months it was followed by resection of the aneurysm with a favorable outcome.

Adult↗
PubMed2006

Considerations on the phrenic ganglia.

UNLABELLED: The phrenic ganglion is described as a small ganglion located at the junction of the right phrenic nerve and branches of the celiac plexus, on the diaphragm. The descriptions of this ganglion are few and incomplete and justify the present study which has been performed macroscopically by dissection and microscopically using silver stained (the method of Bielschowsky) drawn pieces. Dissections of 10 human adult specimens showed one or more ganglia located at the level of the terminal division of the right diaphragmatic artery; these ganglia belong to a trunk linking the right phrenic nerve and the celiac ganglion. In some specimens that nervous trunk was replaced by a ganglionated plexus. That trunk--the diaphragmatic nerve--attaches to a distinctive projection of the celiac ganglion; it may be double, but there is one ganglionated component. No left phrenic ganglia were detected. The macroscopic phrenic ganglia are distributed as follows: the lower to the adrenal gland and the upper to the diaphragm. Microscopically, the ganglia had autonomic characteristics; intrinsic microganglia were also detected within the diaphragmatic nerve. Moreover, periadventitial nervous cells were detected on the right inferior phrenic artery. IN CONCLUSION: (1) the phrenic ganglia seem to be constant structures on the right-hand side; (2) their number is variable--it may be the result of individual fragmentation or coalescence during development; (3) these ganglia may be either adrenal vasomotor or diaphragmatic vasomotor, and functionally belong to the celiac plexus; (4) intrinsic neural and periarterial locations are also possible for macroscopically undetectable populations of autonomic nervous cells.

Adult↗
PubMed2006

EUS-guided celiac block and neurolysis.

Abdominal pain related to pancreatic cancer or chronic pancreatitis can be a disabling and difficult symptom to treat for patients, their families, and physicians. Pharmacologic therapy with nonsteroidal anti-inflammatory drugs is usually ineffective. Opiate analgesics may not be well tolerated and can lead to dependence. Endoscopic ultrasound-guided celiac plexus block offers a potential adjunct treatment for pain control.

Celiac Plexus↗
PubMed2005

Palliative gastroenterology.

Continuous improvements in endoscopic imaging and accessories have opened up a field of interventional endoscopy. This highly technical offshoot of gastroenterology uses not just standard endoscopic techniques but also newer endoscopic ultrasound (EUS) imaging or fluoroscopic monitoring to facilitate procedures that were once performed either surgically or percutaneously, if at all. This review will update the role of these novel procedures that can be used to assist in the palliative care of patients whose malignancies involve the gastrointestinal tract. The emphasis will be on those palliative interventions that are used to overcome intestinal obstruction in the gastrointestinal tract and restore luminal patency. The role of EUS-guided celiac plexus neurolysis to assist in pain control, especially in patients with pancreatic malignancies, will also be detailed.

Biliary Tract Diseases↗
PubMed2002

Metastatic pancreatic cancer.

Metastatic pancreatic cancer is one of the leading causes of cancer-related deaths in North America and Europe. In the past, patients with metastatic pancreatic cancer have had few treatment options. However, recently, several effective palliative therapies and procedures have become available. The systemic administration of gemcitabine has been shown to result in clinical benefit and in a prolongation of median survival, and is now established as the standard first-line treatment for patients with metastatic pancreatic cancer. Clinical trials are exploring whether the use of gemcitabine-based chemotherapy combinations will result in further benefit. Several novel chemotherapeutic and biologic agents appear promising, and are likely to play a role in the treatment of patients with pancreatic cancer in the future. Palliative procedures, such as biliary or duodenal stenting and celiac plexus blockade, should be considered in conjunction with systemic therapy in patients with specific complications from pancreatic cancer.

Antineoplastic Agents↗
PubMed1985

[Electrophysiologic and histochemical characteristics of the fiber composition of the subdiaphragmatic portion of the vagus nerves].

The fibre composition of subphrenic branches of the vagus nerves was studied electrophysiologically and histochemically. In anaesthetized cats, the presence of multicomponent electrical responses was found during stimulation of preganglionic fibres of splanchnic nerves in the splanchnic branch of the dorsal vagus trunk; the presence of synaptically interrupted fibres was shown. Histochemically, adrenergic fibres were found both in the central and in the peripheral stumps of subphrenic branches of the vagus nerves. Most strongly fluorescent fibres were regularly found in the peripheral stump of the splanchnic branch of the dorsal vagus trunk. The data obtained suggest that processes of ganglionic neurons of the celiac plexus ascend within splanchnic and other branches of the vagus nerves.

Adrenergic Fibers↗
PubMed2003

Anatomical study of the pancreas in the house musk shrew (Suncus murinus), with special reference to the blood supply and innervation.

To examine the macroscopic structure, blood supply, and innervation of the pancreas in the house musk shrew (Suncus murinus), we performed gross anatomical dissection and whole-mount immunostaining of the autonomic nerve of Suncus pancreases based on neurofilament protein (NFP) immunoreactivity. The adult Suncus pancreas is clearly separated into right and left lobes that are not fused. The right lobe of the Suncus pancreas is located in the dorsum of the duodenum and to the right of the common bile duct independently. The right lobe is supplied by branches of the superior mesenteric artery, and is innervated by branches that originate from the superior mesenteric plexus and run along the arterial branches of the superior mesenteric artery. The left lobe occupies 9/10 of the entire pancreas and is located to the left of the common bile duct. It is supplied mainly by branches of the splenic and common hepatic arteries, and is innervated by branches that originate from the celiac plexus and run along the splenic and common hepatic arteries. According to previous studies on the blood supply and innervation of the human pancreas, the right and left lobes of the Suncus pancreas correspond to the pancreatic parts derived from the ventral and dorsal pancreatic buds. The current results suggest that the Suncus pancreas is a suitable experimental model for studying the development of the human pancreas.

Animals↗
PubMed1978

A familial neuronal disease presenting as intestinal pseudoobstruction.

The purpose of this paper is to describe 2 siblings who had a generalized neurological disease which presented as intestinal pseudoobstruction. The siblings had 40-year histories of abdominal pain, distention, and vomiting as well as gait ataxia, small, irregular, poorly reactive pupils, dysarthria, absent deep tendon reflexes, and impaired vibratory and position senses. Compared with age-matched controls, they had inappropriate blood pressure responses to phenylephrine, the Valsalva maneuver, and upright posture, lack of sweating on warming, and pupillary denervation hypersensitivity. Radiographs revealed hyperactive, nonpropulsive contractions of a dilated esophagus and small intestine and extensive colonic diverticulosis. Esophageal manometry recorded repetitive, spontaneous, nonperistaltic waves and positive Mechyolyl tests. Postmortem examinations showed degeneration of the myenteric plexuses of the esophagus, small intestine, and colon of both patients. Myenteric plexus neurons were significantly reduced in number compared with 7 controls. About one-third of the siblings' neurons contained round, eosinophilic intranuclear inclusions, which, by histochemistry, were composed of protein by lacked RNA, DNA, carbohydrate, and fat. By electron microscopy the inclusions consisted of an irregular array of nonviral, nonmembrane-bounded filaments. Neurons and glial cells of the brain, spinal cord, dorsal root, and celiac plexus ganglia contained identical intranuclear inclusions. Intestinal smooth muscle was normal. These 2 siblings represent a unique disease in which degeneration of the myenteric plexus resulted in hyperactive but uncoordinated smooth muscle activity and the clinical syndrome of intestinal pseudoobstruction, the presenting manifestation of their neurological disease.

Brain↗
PubMedDate not supplied

Ultrasonography of the pancreas. 6. Endoscopic imaging.

EUS is a high-resolution technique for pancreatic imaging. EUS has applictions in detecting and staging pancreatic tumors, EUS guided FNA of the pancreas for tissue diagnosis, and evaluation of chronic pancreatitis as well as EUS guided therapy such as celiac plexus block. This is a review of EUS imaging (EUS) of the pancreas covering technical aspects, clinical indications, advantages, and pitfalls as well as emerging trends in the field.

Biopsy, Needle↗
PubMed1987

Pain of chronic pancreatitis: etiology, natural history, therapy.

The pain of chronic pancreatitis can be tremendously disabling. The pathogenesis of this pain is still poorly understood, but there is good evidence demonstrating an inverse relationship with the degree of pancreatic insufficiency. Pancreatic enzyme therapy of pain and celiac plexus blocks carry promise, but larger studies with these modalities are needed. Surgery for pain relief is the last resort and should be based on pancreatic duct anatomy.

Autonomic Nerve Block↗