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PubMed1999

Effects of bile duct ligation and captopril on salt appetite and renin-aldosterone axis in rats.

A ligation of the common bile duct (BDL) produces cholestasis and hypotension and increases the daily ingestion of sodium chloride solutions in rats. Low-dose captopril (CAP) treatment also modifies the ingestion of water and sodium in naive rats, and may do so in cholestatic rats. This study examined whether the elevated ingestion of saline by Long-Evans rats after BDL is associated with increased plasma renin activity (PRA), and whether treatment with a low dose of the angiotensin converting-enzyme inhibitor CAP further exacerbates fluid intake and PRA after BDL. In these experiments water and 0.3 M saline intake and PRA and plasma aldosterone (PA) were measured in naive and CAP-treated BDL and sham-ligated rats. We found that BDL elevated rats' daily saline intake 2 weeks after the ligation procedure but had no effect on PRA. CAP (0.1 mg/mL) placed in the drinking water of some BDL rats further increased saline intake. Both PA and hematocrits tended to be reduced in BDL rats, whereas PRA was elevated in both BDL and sham-ligated rats receiving CAP in the drinking water or by gavage (0.1 mg/mL in 10 mL/kg). The data suggest that the ingestion of saline by rats can be modified by BDL and CAP administration, but that exaggerated saline intake in BDL rats is not associated with excessive renin secretion.

Aldosterone↗
PubMed2003

Success and complications of four-duct ligation for sialorrhea.

OBJECTIVE: Sialorrhea can have a significant negative effect on quality of life, impeding social interactions and severely limiting employment opportunities. Many surgical options to control sialorrhea have been reported. One of the newest procedures is combined ligation of the submandibular and parotid ducts, reported only once in the literature in one series of five patients to date. We have compared results in our first 21 patients undergoing this procedure with results reported in the literature for other procedures to treat sialorrhea. MATERIALS AND METHODS: We retrospectively reviewed medical records of all 21 children we treated with four-duct ligation, a relatively simple intraoral procedure to control sialorrhea, between August 1999 and September 2000 and contacted primary caregivers by telephone to answer a questionnaire regarding objective and subjective results of surgery. Surgery was considered successful when caregivers rated patients as 'much better' or 'better' after surgery. RESULTS: Follow-up was completed in all 21 of the patients 1-14 months after surgery. The success rate of four-duct ligation ('much better' or 'better' after surgery) was 81%, and no patient's sialorrhea problem was worse after surgery. Major complications occurred in two (10%) of the patients (one ranula and one case of sialoadenitis), which were both successfully treated surgically. Minor complications occurred in four (19%) of the patients, tongue swelling that prolonged hospitalization, a ranula that resolved, and prolonged submandibular gland swelling that resolved (two cases). More than half of patients were discharged the day of or the day after surgery. CONCLUSIONS: Four-duct ligation should be considered when surgery is indicated to treat sialorrhea.

Follow-Up Studies↗
PubMed2000

The compensatory hyperplasia (liver regeneration) following ligation of a portal branch is initiated before the atrophy of the deprived lobes.

BACKGROUND/AIMS: In rats, partial ligation of portal branches produces atrophy of the deprived lobes and hypertrophy of the intact lobes. The hepatocyte proliferation observed in the nondeprived lobes is viewed as a compensatory hyperplasia, implying that the atrophy somewhat precedes the initiation of the proliferative response. As this has not been demonstrated, the time course and magnitude of those two sequences of events were investigated and compared with the well-defined response to a partial hepatectomy. METHODS: The portal branch feeding the anterior liver lobes was ligated in male Wistar rats. One-third and two-thirds partial hepatectomies were also performed. Liver weight, the aminopyrine demethylation rate, an index of the liver mass, the DNA content and various indices of cell proliferation were measured. RESULTS: Resection of the anterior lobes (PH) or ligation of their portal blood supply (PBL) induced a marked DNA synthesis in the posterior lobes (3H-thymidine incorporation) reaching its maximum 24 h after both interventions. This response can even be accelerated by performing a sham operation 6 h before the PBL. The process leading to DNA synthesis thus seems to start as early after PBL as after a PH, although the weight of the liver or the aminopyrine demethylation rate was nearly unchanged 2 h following PBL. The initiation of the proliferative response clearly precedes and is thus independent of the reduction of the liver mass. On the other hand, the progressive reduction of the liver mass seems to determine the magnitude of the proliferative response, which is, for instance, greatly increased following the excision of the deprived lobes, as late as 10 h after ligation of their portal branches. In comparison with the results obtained after a 113 PH, the peak of DNA synthesis at the 24th hour is greater than predicted by the liver weight loss, but this parameter could underestimate the reduction of the functional liver mass. CONCLUSION: The proliferative response following a PBL can be divided into an early phase occurring independently of the reduction of the liver mass and a late phase controlled by this reduction. The paradox of the proliferative response which seems to start before the atrophy to be compensated is resolved by this hypothesis.

Animals↗
PubMed2002

Effect of uterine horn ligation on bone mass: an experimental study in rats.

OBJECTIVE: After tubal ligation, normal bone mass in the presence of gonadal deficit has been reported. These incongruent results motivated us to examine the topic. STUDY DESIGN: Bone mass was assessed by densitometry and ultrasonography 60 days after surgery on 100-day-old female Wistar rats. Fifteen Wistar rats with uterine horn ligation (TL) were compared with 15 unoperated, 15 with a sham uterine horn ligation (Sham-TL), and 15 ovariectomized (OVX), using ANOVA and a correlation test to determine the relations between results. RESULTS: Femoral and vertebral bone mass were significantly lower in the OVX y TL groups than in unoperated and controls groups (P<0.0001). CONCLUSIONS: Our study revealed significantly lower axial and peripheral bone mass in rats with uterine horn ligation.

Animals↗
PubMed1999

Mechanical hyperalgesia after spinal nerve ligation in rat is not reversed by intraplantar or systemic administration of adrenergic antagonists.

The development of alpha-adrenergic sensitivity in cutaneous nociceptors has been postulated as a mechanism for sympathetically maintained pain (SMP). In order to characterize the adrenergic receptors involved, we investigated the effects of intraplantar administration of alpha1-(prazosin) and alpha2-(yohimbine) adrenergic antagonists and systemic injection of phentolamine, a non-specific alpha-adrenergic blocker, on allodynic/hyperalgesic behavior in an animal model thought to mimic SMP in humans. Peripheral neuropathy in rats was induced by tight ligation of the L5/L6 spinal nerves. Mechanical hyperalgesia was quantified with von Frey hairs applied either for 3 s or repetitively to the plantar surface of the hindpaw. Responses to the 3 s duration stimulus were used to determine the paw withdrawal threshold with the up-down paradigm and repetitive stimuli were used to determine the response incidence of paw withdrawal to a given von Frey hair. Mechanical thresholds on the ipsilateral paw decreased significantly after ligation and were stable over the following 3 weeks. Intradermal administration of yohimbine or prazosin did not significantly alleviate mechanical hyperalgesia in L5/L6 ligated animals. Also systemic administration of phentolamine (1 and 5 mg/kg) did not alleviate the increased incidence of paw withdrawal in L5/L6 spinal nerve ligated animals. These results suggest that an alpha adrenergic interaction between sympathetic efferent and somatic afferent fibers does not play a critical role for the maintenance of mechanical hyperalgesia in this model for neuropathic pain.

Adrenergic alpha-1 Receptor Antagonists↗
PubMed1999

Behavioural measures of depression and anxiety in rats with spinal nerve ligation-induced neuropathy.

The behaviour of rats with spinal nerve ligation-induced neuropathic pain was studied using tests developed to measure depression and anxiety. Adult male Sprague-Dawley rats were tested with the open field test, elevated plus maze, two compartment test and forced swimming test. Spontaneous motility was measured in a photocell observation box. Mechanical sensitivity was tested with von Frey hairs and cold sensitivity with the acetone drop test. The L5-6 spinal nerves were ligated or a sham operation was performed and the rats were followed for 2 weeks before the same set of tests were repeated. Most of the neuropathy operated rats had mechanical and cold allodynia. With post-injury there was a significant decrease in the activity in the open field test and motility box tests, when compared with the pre-injury results. In the elevated plus maze test there was a significant reduction in the motility, but there was no change in the time spent in the closed wings. In the two compartment test there were no significant differences between the pre- and post-injury results. There were no differences between the rats with spinal nerve ligation injury and the sham operated rats in any of the tests. The results were also comparable when rats that developed a high degree of neuropathy were compared with the rats with low degree of neuropathy and the sham operated group. In conclusion, spinal nerve ligation injury of the spinal nerves L5-6 induces mechanical and cold allodynia, but it does not seem to produce general suffering or measurable anxiety to the animals. Furthermore, tests for anxiety and depression were not able to predict which animals were vulnerable to express symptoms of neuropathic pain after nerve injury.

Animals↗
PubMed2001

Anterograde and retrograde transport of active extracellular signal-related kinase 1 (ERK1) in the ligated rat sciatic nerve.

Neurons are one of the most polarized cells and often the nerve terminals may be located long distances from the cell body, thus signal transduction in neurons unlike other cells may need to be conducted over large distances. The mitogen-activated protein/extracellular signal-regulated kinases (MAP kinases or ERKs) regulate a diverse array of functions and in neurons, the ERK signalling pathways appear to have an important role in activity-dependent regulation of neuronal function. Using the ligated rat sciatic nerve as an experimental model we previously showed that the ERK1/2, MAP/ERK kinase (MEK1/2) and the p110 catalytic subunit of PI3-kinase are transported in the rat sciatic nerve. We have extended these findings to determine if these proteins are transported in the active state using antibodies that specifically detect the active form of ERK1/2, MEK1/2 and AKT which is activated downstream of PI3-kinase. We show significant accumulation of active ERK1 on the proximal and distal sides of a nerve ligation after 16 h. Active ERK2 also appeared to be accumulating at the ligature, however this did not reach statistical significance. In contrast there was not any significant accumulation of active MEK1/2 or active AKT. A component of both active ERK1 and active ERK2 is present in between the two ligations suggesting they are also present in the surrounding Schwann cells and are activated in response to nerve injury. Taken together our results suggest that a component of the accumulation of active ERK1 on the distal and proximal side of the nerve ligations results from transport in the anterograde and retrograde direction in the rat sciatic nerve.

Animals↗
PubMed2002

Cutaneous vascular responses evoked by noxious stimulation in rats with the spinal nerve ligation-induced model of neuropathy.

Antidromic activation of nociceptive nerve fibres innervating the skin produces an axon reflex that involves extravasation and vasodilation of cutaneous blood vessels. We determined whether the axon reflex of the hindlimb skin is influenced by an experimental model of neuropathy induced by unilateral ligation of spinal nerves L(5) and L(6) in the rat. Ligation of spinal nerves induced symptoms mimicking tactile allodynia, as indicated by a marked decrease of the hindlimb withdrawal threshold to mechanical stimulation. The axon reflex induced by antidromic electrical stimulation of nociceptive fibres innervating the plantar skin ipsilateral to the ligation was attenuated according to determination of extravasation response and blood flow response. Lidocaine block or transection of the sciatic nerve of the neuropathic limb did not induce any change in basal blood flow of the plantar skin. The results indicate that ligation of spinal nerves induces an attenuation of the axon reflex. This attenuation reflects a decrease in the efferent function of primary afferent nociceptors innervating the hypersensitive skin of the hindpaw. The attenuation of antidromically-induced vascular responses was not caused by overriding sympathetic activity, as indicated by lack of blood flow effects by lidocaine blocks or a transection of the sciatic nerve.

Anesthetics, Local↗
PubMed2002

Influence of portal vein and liver artery ligation on the toxicokinetics of soman in rabbits.

The portal vein, liver artery ligation treatment and the portal vein ligation treatment could increase the concentration of P(-) soman in rabbit blood 3.6-19.3 times as compared with soman control group at each time points after soman injection (43.2 microgkg(-1), i.v.). Toxicokinetics parameters showed that portal vein, liver artery ligation treatment and portal vein ligation treatment could reduce the clearance (CL) and distribution volume (V(d)). Meanwhile, they could significantly increase the AUC of soman in rabbits from 2.08+/-0.154 to 18.2+/-2.96 and 22.9+/-3.73 mg s l(-1), respectively. All these data showed that the liver and intestine play a very important role on elimination the free soman in rabbit's blood at high dosing of soman.

Animals↗
PubMed1997

Subfascial endoscopic perforator ligation: an analysis of early clinical outcomes and cost.

PURPOSE: Early results of subfascial endoscopic perforator surgery (SEPS) were examined. Data on ulcer healing, complications, and costs are presented. METHODS: Data were prospectively collected for all patients who underwent SEPS at our institution. A concurrent control group was not available because primary open perforator ligation is no longer performed at our hospital. Preoperative assessment included duplex scanning (valve closure times and perforator mapping), plethysmography, and phlebography. Completeness of therapy was assessed with postoperative duplex mapping of perforating veins. Clinical status was monitored after surgery, and actual costs, including equipment, personnel, and facilities management, are reported. RESULTS: Eighteen procedures were performed in 15 patients (mean age, 52 years; range, 42 to 65 years). Two patients underwent bilateral SEPS, and one patient underwent a second procedure on the same leg. Active ulceration (class 6) was present in 14 of 18 limbs (78%), recently healed ulcers (class 5) in two of 18 (11%), and lipodermatosclerosis with edema (class 4) in two. Deep venous insufficiency was present in 14 of 18 (78%). The number of perforating veins ligated per leg ranged from 0 to 12 (mean, 4.3). Follow-up ranged from 3 to 64 weeks (mean, 22 weeks). Complete ulcer healing occurred in eight of 14 limbs (57%) at a mean of 14 weeks. Reduction in ulcer size was noted in four of 14 (29%), and two limbs were not improved. There were no new ulcers. Residual perforating veins were noted in four of 18 limbs. None of the limbs with residual perforating veins had complete healing of ulceration. Operating room costs were higher than those associated with limited-incision open perforator ligation ($2570 vs $1883). CONCLUSION: These preliminary data suggest that when used as part of a treatment plan to correct deep and superficial venous insufficiency SEPS results in a high rate of wound healing, with no recurrent ulceration in this series. Increased operating room costs associated with longer operations and greater disposable expenses will likely be overcome by shortened length of stay and diminished wound complications. These findings emphasize the importance of ligating all incompetent perforating veins, as ulcer healing was never achieved when residual perforating veins were found at follow-up.

Case-Control Studies↗
PubMed1999

Emphysema surgery--loop ligation approach.

OBJECTIVES: To demonstrate the efficacy of using thoracoscopic endoloop ligation of bullae in patients with bullous emphysema. METHODS: From 1992 to 1997, 93 advanced age (mean age, 66 years) and oxygen dependency patients underwent thoracoscopic procedure using endoloop ligation for treatment of bullous emphysema. Clinical data were collected from chart review. Thoracoscopic loop ligation of bulla was carried out under general anesthesia with double lumen endotracheal tube and single lung ventilation. RESULTS: Eighty-two patients (88%) exhibited subjective improvement in their symptom status at 3-month follow-up (from grade 2 or 3 to grade 1 or 2) according to the modified Medical Research Council dyspnea scale. The mean duration of chest drainage was 7.5 days (range, 4-19 days). Average hospital stay was 9.5 (range, 5-26) days. There was no post-operative death. A comparison of pre-operative and post-operative functional evaluation was available in 27 patients who showed an average increase in FEV1 (from 0.89 to 1.12 l) and declined in residual volume after operation. Complications include persistent airleak over 10 days in nine patients (9.7%), wound infection in three patients and localized empyema in five patients. There was no recurrent after a mean follow-up of 37 months. CONCLUSION: Thoracoscopic loop ligation of bulla has proven to be a safe, reliable and cost effective means of technique for bullous emphysema.

Aged↗
PubMed2003

Ligation of the pancreatic duct during difficult operative circumstances.

BACKGROUND: The current approach to managing the distal pancreas after pancreaticoduodenectomy is to anastomose the stump to either the jejunum or stomach, but pancreatic ductal occlusion without anastomosis of the pancreatic remnant remains an option during difficult operative circumstances. This article describes some situations in which distal pancreatic ductal ligation may be of use and reviews the morbidity associated with this procedure. STUDY DESIGN: Review was done of a prospectively kept database of operative and pathology reports and of both immediate and 3-month to 6-year followup data of seven patients who underwent ductal occlusion during pancreaticoduodenectomy or central pancreatectomy. RESULTS: Ductal occlusion was performed in three circumstances: 1. necessity for expedient termination of the operation; 2. short jejunal mesentery allowing only a tension-free biliary or pancreatic anastomosis; and 3. massive jejunal edema that would result in a tenuous anastomosis. Two patients developed a fistula. One patient had dense residual pancreatic fibrosis, which resolved after 5 days; the other patient had a normal residual pancreas and subsequently underwent a pancreaticojejunostomy. Three patients developed acute pancreatitis (two had a normal and one had mild to moderate fibrosis in the residual pancreas) and one of these developed a peripancreatic abscess and late pseudocyst. Four patients with dense fibrosis did not develop acute pancreatitis. No patient developed either overt or worsening diabetes during the limited followup. None of the patients required enzyme supplementation, but all voluntarily maintained a low-fat diet. CONCLUSIONS: The development of complications after ductal ligation appears to be associated with the degree of fibrosis of the residual distal gland. Acute pancreatitis and fistula are the major complications but are associated with a low mortality. Diabetes is a potential late problem. The morbidity associated with ductal ligation is generally accepted as being greater than anastomosis, but ligation can be considered as an alternative in difficult circumstances where anastomosis of the distal pancreatic stump is believed to be unwise.

Anastomosis, Surgical↗
PubMed1985

An evaluation and clinical study of severe epistaxis treated by arterial ligation.

Forty-three cases of intractable epistaxis treated by major arterial ligation are described, with follow-up in 41 cases of up to 11 years. It would appear that this treatment is effective in the control of epistaxis, and there was no evidence of any long-term detrimental effect on the nose, or of any significant mortality. External carotid artery ligation is advocated in the elderly and debilitated case, whilst internal maxillary artery ligation together with anterior ethmoidal artery ligation is indicated in the younger age group, or in the elective case. Evaluation of the results is discussed together with alternative methods of management.

Adolescent↗
PubMed1997

Oroantral fistula: a complication of transantral ligation of the internal maxillary artery for epistaxis.

Transantral ligation of the internal maxillary artery (IMAX) is a well-described option for surgical management of posterior epistaxis not controlled by anterior and posterior packing. Advocates for this procedure argue that it reduces the morbidity, length of hospital stay and financial cost associated with prolonged nasal packing. The procedure is carried out through a Caldwell-Luc approach and the IMAX is clipped in the pterygomaxillary fossa. Fashioning of a nasoantral window is optional and its inclusion usually depends on the integrity of the sinus ostium. The commonest complications of transantral IMAX ligation occur when local structures including the inferior orbital and anterior superior alveolar nerves are damaged. The incidence of oroantral fistula following IMAX ligation is very low but those cases reported have been associated with the failure to create a nasoantral drainage window. We report two cases of persistent oroantral fistula complicating transantral internal maxillary artery ligation. No nasoantral window was fashioned in either of these cases.

Adult↗
PubMed2002

Hyperplasia of myoepithelial cells expressing calponin during atrophy of the rat parotid gland induced by duct ligation.

The number and location of myoepithelial cells in the rat parotid gland submitted to surgical ligation of its main excretory duct were studied through immunohistochemical labelling for calponin. These cells were labelled by the streptavidin-biotin method using anti-calponin primary antibody, and their number was determined during each step of glandular atrophy, i.e., at time zero (control) and 1, 7, 15, 21, 30 and 60 days after ligation. Morphological analysis showed a gradual decrease and fibrosis of the glandular lobules accompanied by disappearance of the acini and the occurrence of duct-like structures. The expression of calponin was observed in all specimens analysed, being restricted to myoepithelial cells. Labelling revealed the distribution of myoepithelial cells around the acini and intercalated ducts in the control group and around duct-like structures later during the course of atrophy. Quantitative analysis demonstrated significant increase in the number of myoepithelial cells up to day 7 post-ligation, followed by gradual increases which, however, were not statistically significant. These results suggest that myoepithelial cells proliferate intensely up to day 7 post-ligation, an event that coincides with a higher rate of disappearance of acinar cells. After this period, the elevatednumber of cells observed at the end of the previous period is maintained.

Animals↗
PubMed2003

High ligation to treat pain in varicocele.

PURPOSE: There are limited data about the effectiveness of surgery in patients with painful varicocele. We report a retrospective study done for the follow up on all varicocele high ligations performed for pain to evaluate the effectiveness of the operations. MATERIALS AND METHODS: The patients who were all physically active workers and who underwent high inguinal ligation of varicocele for pain from January 1995 to January 2000, were invited for interviews. Their charts were reviewed to document patient age, grade and location of varicocele, duration and quality of pain, response to conservative treatment. All patients who could be contacted were interviewed for resolution of pain and complications, their physical examinations were made. RESULTS: 87 of 140 (62.1%) patients were available for the follow up. Median patient age was 26 (15 to 34) years old. The varicocele was on the left side in 82 patients and bilateral in 5. The pain was dull in 42, throbbing in 25, sharp in 6 and as a pulling sensation in 14. The longest conservative therapy given in the literature failed in all patients. Varicocele grades were as follows: Grade I in 17, Grade II in 34 and Grade III in 36 patients. High inguinal ligation was used in all patients. 72 (82.8%) patients reported complete resolution, 8 (9.2%) patients reported partial response, 7 (8%) patients had persistant pain. CONCLUSIONS: High inguinal ligation is effective in the treatment of painful varicocele in highly selected patients. Prospective randomized studies are needed comparing surgical and conservative treatments.

Adolescent↗
PubMed2003

Contemporary surgical treatment of epistaxis. What is the evidence for sphenopalatine artery ligation?

The optimal surgical management for failed conservative measures in epistaxis remains unclear. Given the growing enthusiasm for endoscopic transnasal sphenopalatine artery ligation, it is prudent and timely to evaluate the evidence base for this technique. This study aims to analyse the current evidence for transnasal endoscopic sphenopalatine artery ligation by reviewing the literature and also by comparing the results with other approaches to the management of epistaxis. A detailed literature search identified 11 publications relating to endoscopic sphenopalatine artery ligation. The total number of patients in the pooled series was 127, of which 98% had control of epistaxis following surgery. These results compared favourably to the results of most other techniques used in the modern treatment of epistaxis. Nonetheless, the total number of patients in the 11 case series is small. It is therefore recommended that all units using this technique audit their results to see if the high success rates achieved in the literature are reproducible. If this is the case, then endoscopic sphenopalatine artery ligation may indeed be the surgical answer to intractable posterior epistaxis.

Endoscopy↗
PubMed1999

Endoscopic variceal ligation is a sufficient procedure for the treatment of oesophageal varices in patients with hepatitis C liver cirrhosis: comparison with injection sclerotherapy.

AIMS: Endoscopic variceal ligation (EVL) is a recently developed alternative to endoscopic injection sclerotherapy (EIS) for the treatment of oesophageal varices. Endoscopic variceal ligation and EIS were compared in an attempt to clarify the efficacy and safety of EVL for patients with cirrhosis due to hepatitis C. METHODS: Endoscopic variceal ligation was performed in 60 patients and EIS in 30. Varices were eradicated in all patients by EVL and 87% (26 out of 30) by EIS. RESULTS: There was no significant difference between EVL and EIS in relation to the incidence of bleeding and the 5 year survival rate after treatment. There were no severe complications except mild substernal pain after EVL, while pulmonary embolism occurred in one patient receiving EIS. CONCLUSIONS: Endoscopic variceal ligation is a safe and effective technique for eradicating oesophageal varices in patients with hepatitis C cirrhosis.

Esophageal and Gastric Varices↗