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At least 109 records · Page 6Linked to original sources
PubMed1998

Use of neutron therapy in the management of locally advanced nonresectable primary or recurrent rectal cancer.

Inoperable locally advanced or inoperable recurrent rectal cancer is a difficult problem. Tenesmus, discharge, bleeding and pelvic pain are frequently present and often are associated with infiltration of the sacral plexus. The value of radiotherapy in managing such patients is being appreciated, although up to 40% of the treated patients have no symptomatic response. Improvement in tumor response and control has been scored through efforts to overcome the radio resistance of the hypoxic tumor cells by neutron irradiation. This article is an account of the activity of neutron radiotherapy in such patients. Over 350 patients were entered in studies comparing neutrons used alone and neutrons used in a mixed-beam treatment schedule. At present no therapeutic gain for long-lasting survival has been achieved; however, local control and pain improvement seems to be better with neutrons than with photons.

Humans↗
PubMed1989

Intra-operative spinal cord evoked potentials during cervical and lumbo-sacral microsurgical DREZ-tomy (MDT) for chronic pain and spasticity (preliminary data).

We have undertaken the intra-operative study of spinal cord surface evoked potentials in patients operated upon for pain and/or spasticity using the microsurgical DREZ-tomy (MDT) procedure. The goals of this work were 1) to collect data on spinal cord evoked potential components and 2) to analyze the effects of MDT on spinal cord physiology. The MDT consists of a therapeutic lesion in the ventro-lateral aspect of the dorsal root entry zone, directed to the activatory circuitry, and aiming at returning the dorsal horn physiology towards inhibition. Averaged evoked potentials to peripheral nerve electrical stimulations were obtained from various loci on the surface of the dorsal columns of the cervical and lumbo-sacral spinal cord in 19 patients, using a small uninsulated silver ball electrode. An initial far-field positivity was found, corresponding to a compound action potential in the proximal part of the brachial (or lumbo-sacral) plexus. Pre-synaptic compound action potentials were identified, most often composed of multiple successive sharp peaks. A post-synaptic field potential generated in the dorsal horn was recognized. The MDT caused an immediate and irreversible decrease of amplitude down to a disappearance of the dorsal horn potential. This decrement was proportional to the amount of operated cord segments. In contrast, there has been a relative post-MDT sparing of the pre-synaptic action potentials originating from the operated cord segments, and the scalp contralateral parietal N 20 has been only reversibly affected by the therapeutic lesion. We thus argue for a specific involvement of dorsal horn physiology by the MDT, with a relative sparing of the dorsal column system.

Electric Stimulation↗
PubMed1991

The "critical zones" of entrapment of the nerves of the lower limb.

The author has studied, in a group of 40 dissections on cadavers of individuals of different ages, the main "critical zones" of entrapment of some terminal branches of the lumbo-sacral plexus, which include canals (fibrous, osteo-fibrous, fibro-muscular), intervals (intermuscular, fibro-muscular, musculo-ligamentous), rings (fibrous or fibro-muscular) and foramina. They provide the topographical anatomical basis for possible compressive phenomena of the nerves of the lower limb.

Fascia↗
PubMed2000

Hemorrhoidectomy with posterior perineal block: experience with 400 cases.

PURPOSE: The aim of this study was to evaluate the advantages and feasibility of hemorrhoidectomy using regional anesthesia (posterior perineal block). METHODS: From March 1994 to December 1998 we performed 400 hemorrhoidectomies with regional anesthesia in an overnight-stay regimen in our department (Colo-Rectal Unit). Posterior perineal block involves anesthesia of the deep plains (infiltration of the inferior hemorrhoidal nerves, the posterior branch of the internal pudendal nerves, and the anococcygeal nerves) and anesthesia of the superficial plains (block of the inferior gluteal nerves and of perineal branches of minor nerves from the sacral plexus). RESULTS: Posterior perineal block was always effective; optimal to satisfactory intraoperative analgesia was obtained in 379 patients (95.2 percent), whereas in 17 cases (4.2 percent) intravenous analgesic drugs were administered. No conversion to general anesthesia was needed. Urinary retention was 7.8 percent. In our study most of patients (70 percent) reported no pain at all for five to ten hours. Ninety-two percent of patients were discharged in the first 24 hours. CONCLUSIONS: Posterior perineal block allows the surgeon to perform radical hemorrhoidectomies in an overnight-stay regimen with safe and effective intraoperative and postoperative analgesia, sphincter relaxation, and low incidence of urinary retention. Experience of the surgeon combined with careful surgical handling are of great importance for success in this technique.

Adult↗
PubMed1989

The colon, anorectum, and spinal cord patient. A review of the functional alterations of the denervated hindgut.

As humans have become more mechanized, the number of persons sustaining spinal cord injuries resulting in quadriplegia or paraplegia has increased. Because colorectal function is modulated by a combination of neural, hormonal, and luminal influences, many of the normal regulatory mechanisms remain intact in patients with spinal cord injuries. Management of these patients, however, requires an understanding of altered function in the denervated hindgut. The foregut and midgut are innervated by parasympathetic fibers in the vagus and sympathetic fibers from the lower six thoracic vertebra. In contrast, the hindgut is innervated by parasympathetic fibers arising from the sacral plexus and sympathetic fibers from the lumbar spinal column. Consequently, in most spinal cord injuries, the foregut and midgut remain normally innervated whereas the hindgut looses input from cerebral and spinal cord sources. In high cord lesions this results in decreased colonic motility. In low cord injuries there is loss of inhibitory influences that normally down-regulate left colonic and rectosigmoid sphincter activity. This increased motility causes a loss of left colonic compliance and increases left colonic transit, thus leading to chronic constipation. At the same time in both high and low cord injuries, reflex activity of the anorectum is left unregulated by cerebral input. Once stimulated by distention, the rectum spontaneously evacuates its contents. Thus, fecal impaction and incontinence in these patients principally results from loss of inhibitory influences on rectosigmoid sphincter activity and on rectal reflex activity.

Animals↗
PubMed1992

Continuous lumbosacral block using a Tuohy needle and catheter technique.

Three cases are reported where continuous lumbosacral block was performed using a catheter through an epidural needle technique. Good unilateral lower limb surgical anaesthesia was achieved in all three cases with successful blockade of the lumbar and sacral plexuses. A 17-gauge Tuohy needle was positioned between the transverse processes of L4 and L5 and an epidural catheter inserted into the space between the quadratus lumborum and psoas muscles. Forty to seventy millilitres of local anaesthetic were injected and resulted in good surgical anaesthesia within 12-20 min. Radiographic studies in these patients confirmed placement of the catheter in close proximity to the lumbosacral plexus. Experience in a further 12 cases is also reported. There were no side-effects. The technique is successful and is recommended when unilateral lower limb anaesthetic is required and when spinal and epidural anaesthesia are contraindicated.

Aged↗
PubMed1989

Location of motoneurons innervating the musculus sphincter cloacae in the domestic fowl.

Horseradish peroxidase was injected into the musculus (m.) sphincter cloacae through the mucosa from the lumen side of the cloaca in the domestic fowl. Labeled neurons were found in the ventrolateral area of the ventral horn from the lumbosacral segments 7-9. The craniocaudal distribution of labeled neurons overlapped with that of hindlimb motoneurons. The m. sphincter cloacae is innervated by motoneurons sending axons to the sphincter cloacae either through the connexus caudalis branching from the caudal coxal nerve of the sacral plexus or through the lateral caudal nerve arising from the pudendal plexus.

Animals↗
PubMed2006

Unusual origin of dorsal nerve of penis and abnormal formation of pudendal nerve--clinical significance.

The nerve roots of the sacral plexus are fascinating and critical in the functions of defecation, micturition, parturition, and even participate in the mechanism of male sexual functions of erection and ejaculation. During our routine cadaveric dissection of the right gluteal region of a 45-year-old male cadaver, we came across an unusual origin of the dorsal nerve of the penis (DNP) and abnormal formation of the pudendal nerve. The clinical aspects of the particular variations are discussed.

Cadaver↗
PubMed2005

The mini-invasive anterior extra peritoneal approach to the pelvis.

Retroperitoneal pelvic tumours are rare and their surgical approach is challenging. Various surgical approaches have been proposed. We present here an original mini-invasive anterior retroperitoneal approach the pelvic retroperitoneum, which was successful in a 26-year-old woman who had a benign schwannoma of the left sacral plexus. This technique presents advantages over other techniques that were considered in this case, as the least invasive and safest procedure.

Abdominal Muscles↗
PubMedDate not supplied

Urinary incontinence after bilateral parasacral sciatic-nerve block: report of two cases.

OBJECTIVE: The authors describe the occurrence of urinary incontinence after bilateral parasacral sciatic-nerve blocks. CASE REPORT: Two female patients scheduled for bilateral hallux valgus corrective surgery under bilateral parasacral sciatic-nerve block developed urinary incontinence manifested by 3 episodes of enuresis in the first 5 hours after surgery. Physical examination revealed bilateral perineal and gluteal anesthesia and no bladder distention in both patients. Ten hours after block placement, both patients had recovered perineal sensibility and were able to control micturition. CONCLUSION: Given the anatomic relations between the sacral plexus and the autonomic and somatic afferent and efferent innervation of the bladder and urethra, the urinary incontinence observed in our 2 patients could be explained by loss of afferent activity by spread of the local-anesthetic solution to pelvic nerves, loss of the efferent innervation of the posterior urethral sphincter by spread of the local-anesthetic solution to the urethral branches of the hypogastric plexus, and loss of external urethral sphincter tonus by block of the pudendal nerves. Anesthesiologists should consider the possibility of occurrence of urinary incontinence when performing bilateral parasacral sciatic-nerve blocks.

Adult↗
PubMed2001

On the applicability of two different stimulation techniques for intra-operative peroneal nerve conduction testing.

Dysfunction of the peroneal nerve is an important complication of knee surgery. We compared two monitoring procedures of peroneal nerve function during a standardized operation, a closing wedge high tibial osteotomy. For two types of stimulation the evoked compound motor unit action potentials (CMAPs) were recorded on the tibialis anterior muscle. We used direct perineural electrical stimulation of the common peroneal nerve distal to the cuff (dCMAPs) after nerve identification in the surgical field. Additionally, magnetic stimulation of the sacral plexus proximal to the cuff (pCMAPs) was performed. It was found that dCMAPs were recorded during almost one hour of tourniquet time whereas the pCMAPs were blocked after 25-30 min in 9 out of 11 cases. On the other hand, the CMAP obtained after proximal stimulation exhibited a latency shift with tourniquet yielding an indicator of ischaemic changes present beneath and distal to the tourniquet cuff. In conclusion, different applicabilities of both stimulation techniques under tourniquet conditions were demonstrated.

Action Potentials↗
PubMed2003

Multiple schwannomas of the sciatic nerve.

Schwannomas are rare benign tumours of nerve sheath cells of neural crest origin. Often these tumours are solitary and encapsulated. Multiple schwannomas can arise from the peripheral nervous system including cranial nerves, spinal roots, the brachial and lumbar-sacral plexus or major peripheral nerves. We report an extremely rare case of schwannomatosis of the sciatic nerve in a young female and include a comprehensive literature review. Treatment options are discussed.

Adolescent↗
PubMed2005

Successful treatment of an aggressive recurrent post-menopausal endometriosis with an aromatase inhibitor.

The current case report describes the development and medical treatment of an aggressive pelvic endometrioma in a post-menopausal patient, who had undergone abdominal hysterectomy and salpingo-oophorectomy a decade earlier. The patient was referred to the authors' centre because of right-sided sciatic pain. Three months before her admission she was hospitalized elsewhere due to subacute bowel obstruction. She was operated on and a resection of a part of sigmoid colon and an endometrioma, which was the cause of the subobstruction, was carried out. During the clinical investigation for the right-sided sciatic pain, an intrapelvic mass was found, which was compressing the lumbo-sacral plexus mimicking sciatica. The diagnosis of recurrent endometrioma was confirmed by a computerized tomography-guided biopsy and the decision was made to treat it with an aromatase inhibitor (letrozole). Eighteen months later, the endometrioma was almost completely regressed and the patient was free of symptoms. Medical management of recurrent post-menopausal endometriosis with aromatase inhibitors seems to be an effective alternative treatment to surgery.

Aromatase Inhibitors↗
PubMed2000

Sciatic nerve compression following bone marrow harvest.

We describe a donor who suffered pain secondary to sacral plexus and sciatic nerve compression post bone marrow harvest. Haematoma was demonstrated by magnetic resonance image (MRI) scanning. To our knowledge, this is the first reported case of compression neuropathy post bone marrow harvest documented by MRI scanning. Given the increasing number of bone marrow transplants being performed and the paramount importance of donor safety, compressive neuropathies need to be remembered as rare but debilitating complications of bone marrow harvesting. MRI scanning is a useful modality to investigate severe or neuropathic pain post bone marrow harvest.

Adult↗
PubMed1996

The clinical need for an acute rheumatology referral service.

Should rheumatologists provide an acute referral service for general practitioners (GPs) and other clinical units? Is it cost effective? We prospectively studied acute referrals to one unit over 10 months, recording their source, diagnosis, management and outcome. Current rheumatology patients and cases only needing telephone advice were excluded. There were 253 referrals: 82 from GPs, nine from Accident and Emergency, and 162 from other hospital units. Their diagnoses comprised connective tissue diseases (22), back pain (46), inflammatory arthritis (59), osteoarthritis (22), paediatric cases (11), soft tissue problems (41) and 52 other disorders. Thirty-two needed active treatment within 24 h (classified as emergencies); examples included cerebral lupus, vasculitic pulmonary haemorrhage, retroperitoneal lymphoma with sacral plexus compression, temporal arteritis with reduced visual acuity and acute monoarthritis. All needed immediate therapy; only one died. Most (176 cases) were less urgent and needed advice in 48 h. Examples included osteoporotic vertebral collapse and acute rheumatoid disease. Forty-five could have been seen routinely; examples included lateral epicondylitis and adhesive capsulitis. The service required 1 day per week of medical staff time at an average cost of 45 pounds per case. We concluded that an acute rheumatology service is needed; it can be provided within the working day and is cost effective.

Direct Service Costs↗
PubMed1987

Reconstruction of the pelvis using a composite island flap salvaged from the remaining leg.

The case of a patient who sustained horrific injuries resulting in the loss of his left leg and hemipelvis and damage to the right sacroiliac joint and leg is discussed. The remaining leg was paralyzed as a result of damage to the sacral plexus. As a salvage procedure, a right above-knee amputation was performed, preserving a large composite flap from the distal part of the limb. This flap, consisting of most of the skin and soft tissue of the lower leg, contained within it a 10 cm segment of tibia and fibula. By islanding the flap on a pedicle composed of the femoral vessels, saphenous, and sciatic nerves, it was possible to mobilize it sufficiently far proximally to reconstruct the bone and soft-tissue defect of the contralateral hemipelvis. Seven years after this appalling injury, the patient has achieved a remarkable psychological and functional rehabilitation. He is independent and is successfully pursuing a professional career. This case report is a dramatic illustration of what can be achieved in reconstruction following trauma using salvage techniques.

Adolescent↗
PubMed1990

Needle electrode insertion into tibialis posterior. A new approach.

The tibialis posterior can be a valuable muscle in the electrodiagnostic evaluation of the sacral plexus, lumbosacral roots, lower extremity neuropathies and tibial nerve lesions. It may be under utilized, however, because it is generally considered to be inaccessible to needle examination. The purpose of this study was to compare the widely recommended posterior approach to this muscle to an anterior approach that we define. In six cadaver legs, the safe access to this muscle via the anterior approach was 16.8 +/- 5 mm by contrast to 9.5 +/- 2 mm by the posterior approach. We conclude that the anterior approach to needle electromyography of the tibialis posterior muscle is easier, safer and deserves more widespread practice.

Cadaver↗
PubMed2000

Neuroanatomic substrates of lower extremity somatosensory evoked potentials.

After stimulation of the lower extremity nerve (tibial nerve), N21 and N23 are recorded from L4 and T12 spine respectively. The far-field potentials of P31 and N35 are registered from Fpz-C5s (fifth cervical spine) or CPi (ipsilateral with respect to the side of stimulation)-ear derivation. Additional far-field potentials of P17 and P24 may be recorded from the scalp when a noncephalic (knee) reference is used. The major positive peak, P40, is registered at the vertex and the CPi. Preceding P40, there is a small negative peak, N37, recorded at the contralateral (CPc) hemisphere. Neuroanatomic substrates of these somatosensory evoked potential (SSEP) components are less well clarified compared with those of upper extremity (median nerve) SSEPs, primarily because clinical application of lower extremity SSEPs is more difficult, and all of the aforementioned potentials but one (P40) are not obligatory components. The concept of "paradoxical lateralization" complicates the issue further. Accumulating evidence, however, suggests that the far-field potentials of P17 and P31 arise from the distal portion of the sacral plexus and brainstem respectively. These correspond to P9 and P14 of the median nerve SSEPs respectively. The spinal potential of N23 is equivalent to the N13 cervical potential of the median nerve SSEP. N35 recorded from the ipsilateral hemisphere is analogous to N18 of the median nerve. Paradoxically lateralized P40 has been thought to represent the positive end of a dipole field, reflected by the negativity at the mesial surface of the contralateral hemisphere, and has commonly been considered to be equivalent to the first cortical potentials (N20) of the median nerve SSEP. However, more recent evidence suggests that the primary positivity is at the mesial cortical surface, and it more likely corresponds to P26 of the median nerve SSEP. Thus the first cortical potential corresponding to N20 is probably a small and inconsistent N37 recorded on the contralateral hemisphere. These assumptions need to be verified further by more extensive clinical studies applied to various neurologic disorders.

Afferent Pathways↗