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Causal factors of the intrarachidian angulation of spinal nerves in the cervico-thoracal region.
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Evaluation of recurrent nerve paralysis due to thoracic aortic aneurysm and aneurysm repair.
OBJECTIVES: We sought to clarify the relationship between the outcome of recurrent laryngeal nerve paralysis with the characteristics of the thoracic aortic aneurysm and the surgical procedure used in each patient. METHODS: Nine patients who developed recurrent nerve paralysis (nonsurgical paralysis) due to a thoracic aortic aneurysm alone and 14 patients who underwent artificial vessel replacement for thoracic aortic aneurysm and developed recurrent nerve paralysis postoperatively (surgical paralysis) were evaluated. RESULTS: In the patients with nonsurgical paralysis, the aneurysms were similar in size to those of other patients who underwent surgery of the thoracic aorta and were invariably located near the aortic arch. Aneurysm shape was not associated with nerve paralysis. Surgical paralysis was alleviated in two patients. Surgical paralysis was observed in 9% of those who underwent surgery of the thoracic aorta. Vocal cord mobility recovered in 4 of the 11 patients with surgical paralysis who underwent follow-up. Symptoms were alleviated by rehabilitation in many patients who did not recover vocal cord mobility. The positions of the artificial vessel anastomoses are thought to be closely related to the outcome of paralysis. CONCLUSION: Recurrent nerve paralysis reduced not only the patient's quality of life but also survival by leading to disorders including aspiration pneumonia. Therefore, early rehabilitation should be performed, and surgical treatment should be considered, if necessary, for patients with recurrent nerve paralysis.
Spinal sympathetic reflexes initiated by coronary receptors.
1. The main left coronary artery of vagotomized spinal cats was perfused at different flows and pressures. The changes in pressure were limited to the coronary bed.2. Increased coronary flow which increased coronary arterial pressure provoked a reflex increase in sympathetic discharge in the white ramus of the third thoracic spinal nerve and the inferior cardiac nerve. Reflex reductions in activity were not observed.3. Occlusion of the coronary sinus and myocardial ischaemia, due to cessation of pump inflow, evoked similar reflex increases of sympathetic activity. The effect of myocardial ischaemia was apparent before systemic arterial blood pressure fell or left ventricular end-diastolic pressure rose.4. Increased coronary arterial pressure, myocardial ischaemia and coronary sinus occlusion could activate the same preganglionic neurone.5. The afferent limb of the excitatory coronary-sympathetic reflex was in the cardiac sympathetic nerves, mainly on the left. Afferent nerve fibres running in these nerves and in the third left thoracic sympathetic ramus communicans were excited by increased coronary arterial pressure, myocardial ischaemia, and occlusion of the coronary sinus. Inhibition was not observed. Many of the receptors were further localized by direct probing over the coronary vessels and adjacent myocardium.6. Some receptors were excited by increased coronary arterial pressure alone, others by coronary sinus occlusion, and still others by myocardial ischaemia. In addition, some receptors were excited by all three stimuli.
INDIRECT ACTION OF EPINEPHRINE ON INTRAVENTRICULAR CONDUCTION TIME.
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[Extreme forms of variation in the structure of the thoracic section of the vagus nerve in man].
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Uncommon causes of shoulder pain in the athlete.
Injuries to the shoulder are very common in athletes. In addition to common causes of shoulder pain in the athlete, such as instability, it is important to consider less common causes. Familiarity with these uncommon entities will lead to appropriate diagnosis and treatment in a timely fashion.
Synaptic transmission in thoracic autonomic ganglia of the dog.
Afferent stimulation of one canine thoracic cardiopulmonary nerve can generate compound action potentials in another ipsilateral cardiopulmonary nerve. These compound action potentials persist after acute decentralization of the middle cervical ganglion, indicating that they result from neural activity in the middle cervical ganglion and thoracic nerves. Changing the frequency of stimulation can alter the compound action potentials, suggesting that temporal facilitation or inhibition occurs in this middle cervical ganglion preparation. The compound action potentials can be modified by stimulation of sympathetic preganglionic fibers and by hexamethonium, atropine, phentolamine, propranolol, and (or) manganese. It thus appears that afferent cardiopulmonary nerves can activate efferent cardiopulmonary nerves via synaptic mechanisms in the stellate and middle cervical ganglia. It also appears that these mechanisms involve adrenergic and cholinergic receptors and are influenced by preganglionic sympathetic fibers arising from the cord.
Intercostal nerve nipping due to rib dislocation.
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Central projections of thoracic splanchnic and somatic nerves and the location of sympathetic preganglionic neurons in Xenopus laevis.
The central and peripheral organization of thoracic visceral and somatic nervous elements was studied by applying dextran amines to the proximal cut ends of the thoracic splanchnic and somatic nerves in Xenopus laevis. Many labeled dorsal root ganglion cells of visceral afferents, and all somatic afferents, were located in a single ganglion of one spinal segment, and the two types of cells were distributed topographically within the ganglion. The labeled sympathetic preganglionic neurons were located predominantly in the same area of the thoracic spinal gray as in other frogs and in mammals. The labeled visceral afferents projected to Lissauer's tract and the dorsal funiculus. The visceral fibers of the tract ascended to the level of the subcerebellar area, supplying collateral branches to the lateral one-third of the dorsal horn and to the area of brainstem nuclei, including lateral cervical and descending trigeminal nucleus, and descended to the filum terminale. The visceral fibers of the dorsal funiculus were distributed to the dorsal column nucleus and the solitary tract. A similar longitudinal projection was also seen in the somatic afferents. The dual central pathway of thoracic primary afferents in the anuran spinal cord is a property held in common with mammals, but the widespread rostrocaudal projection through Lissauer's tract may be a characteristic of the anuran central nervous system. In frogs, the direct transmission of primary afferent information to an extremely wide area of the central nervous system may be important for prompt assessment of environmental factors and control of body functions.
Sympathetic and afferent neurones projecting into forelimb and trunk nerves and the anatomical organization of the thoracic sympathetic outflow of the rat.
The anatomy of the cervicothoracic sympathetic nerves was studied in the rat. Details of the arrangements of white and grey rami communicantes and superior cervical, middle cervical and stellate ganglia are given. Dorsal root and sympathetic ganglion neurones projecting to skin and muscle of the forelimb and trunk were labelled retrogradely with horseradish peroxidase (HRP) in order to study their number, segmental distribution and location. HRP was applied to forelimb nerves supplying skeletal muscles (Ramus profundus of radial nerve, RP) or hairy skin (N. cutaneus brachii lateralis superior of axillary nerve, CB), to mixed nerves (median nerve, ME; ulnar nerve, UL; radial nerve, RA) and to segmental thoracic nerves supplying hairy skin of the back (dorsal cutaneous nerve, CD) and to mixed internal intercostal nerves (IC). All sensory and sympathetic neurones were located ipsilaterally. In the forelimb nerves sensory somata were commonly restricted to two or three adjacent dorsal root ganglia (usually C6-7 for CB; C7-8 for ME; C7-Th1 for RA and RP; C8-Th1 for UL). Nearly all of the sympathetic somata were located in the middle cervical and stellate ganglia (fusion of C6-Th3). Some 0-0.4% lay in Th4 and Th5, none in the superior cervical ganglia. In the trunk nerves sensory somata were strictly segmentally organized. Sympathetic somata were distributed more widely over 4-5 segments with 50-55% in the segmental ganglion and up to 41% in the next caudal segment. From the data, it is estimated that 400 sympathetic (28%) and 1050 afferent neurones project into CB, 1660 (29%) and 4050 into RA, 540 (42%) and 760 into RP, 1010 (22%) and 3670 into ME, 880 (22%) and 3040 into UL, 350 (25%) and 1040 into IC and 500 (27%) and 1370 into CD.
[Neurogenic tumors of the thorax].
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[Maculo-tuberculoid leprid appearing at the site of a placental implantation. Hypertrophy of the intercostal nerves].
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THE CHEST ROENTGENOGRAM IN THE DIAGNOSIS OF ACUTE ABDOMINAL DISEASE.
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DIAGNOSTIC IMPLICATIONS OF RIB NOTCHING.
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Synaptic transmission in the chronically decentralized middle cervical and stellate ganglia of the dog.
Afferent stimulation of one thoracic cardiopulmonary nerve generated compound action potentials in the efferent axons of other ipsilateral cardiopulmonary nerves in dogs, 14 days after their thoracic autonomic ganglia had been decentralized. The compound action potentials were influenced by the frequency of activation and (in 5 of 12 dogs) by pharmacological autonomic blocking agents (hexamethonium, atropine, phentolamine, and propranolol). Moreover, they were abolished transiently when chymotrypsin was injected locally into the ganglia, and extendedly when manganese was injected. Thus, synapses that can be activated by stimulation of afferent nerves exist in chronically decentralized thoracic autonomic nerves and ganglia. It is proposed that regulation of the heart and lungs occurs in part via thoracic autonomic neural elements independent of the central nervous system.
THE FIBRE CALIBRE SPECTRA OF SENSORY AND MOTOR FIBRES IN THE INTERCOSTAL NERVES OF THE CAT.
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Expiratory muscle activation by functional magnetic stimulation of thoracic and lumbar spinal nerves.
OBJECTIVE: This study was conducted to stimulate respiratory muscles by functional magnetic stimulation (FMS) of the spinal nerves (T1-L5) to obtain maximum expiratory function. DESIGN: A prospective before and after trial. SETTING: Functional Magnetic Stimulation Laboratory, Spinal Cord Injury Service, VA Palo Alto Health Care System, Palo Alto, CA. PARTICIPANTS: Twelve normal able-bodied subjects. INTERVENTION: A commercially available magnetic stimulator with a round magnetic coil (MC) was used. Respiratory muscle activation was achieved by placing the MC at each spinous process ranging from T1 to L5 vertebral levels. MAIN OUTCOME MEASURE: The planned major outcome was to determine the optimal MC placement for producing maximal expiratory pressure (MEP) and expiratory reserve volume (ERV) by FMS. These measurements were compared with the subjects' voluntary maximal efforts. A profile with varying stimulation intensities was also obtained in select individuals for determining the highest expiratory pressure. RESULTS: Stimulation at the T9 spinal level resulted in the highest mean MEP and ERV. Stimulation between T8 and L5 produced similar MEP and ERV as obtained from the T9 MC placement. The mean maximum MEP and ERV produced by FMS were 76.8 +/- 6.4 cm H2O (7.52 +/- 0.62 kPa) and 1.28 +/- 0.15 L, which were 67% and 79% of the subjects' voluntary maximal efforts, respectively. A stimulation intensity of 80% resulted in the highest expiratory pressure. CONCLUSION: FMS of lower thoracic and lumbar regions produced significant expiratory pressures and volumes. FMS of the expiratory muscles may prove to be a valuable technique for restoring cough in patients with spinal cord injury or other neurologic diseases, and in critical care or perioperative settings.