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At least 145 records · Page 8Linked to original sources
PubMed2002

[Prospects for saving vegetative nerves during operations for cancer of the lower rectum].

The aim of the work was to investigate the possibility to isolate and preserve the vegetative nerve of the pelvis in operations for low rectal cancer. In preparation of 17 corpses of people dead from causes not associated with a pathology of pelvic organs, mainly two forms of the structure of the superior hypogastric plexus were isolated--with many branches and with few branches. The pelvic promontory is taken as a reference-point. Frontal resection and extirpation of the rectum were fulfilled in 17 patients with low rectal cancer using the nerve-preserving technique of operation. Saving the vegetative nerves of the pelvis does not result in greater number of postoperative complications and positively influences the genitourinary function of the patients.

Autonomic Nervous System↗
PubMedDate not supplied

Supportive care in oncology.

Pain management, nutritional support, and psychosocial support are fundamental services that enhance patients' ability to cope with their cancer and its therapy. The common goal of symptom prevention mandates that each of these supportive services be provided to all patients throughout their cancer experience. Comprehensive cancer pain management begins with identifying the origin of all of the patient's pains and treating each one specifically. Pain prevention can be achieved through around-the-clock opioid administration with as-needed supplements for breakthrough pain and dose titration. Common narcotic side effects such as constipation and nausea also must be prevented. Successful opioid analgesia requires that patient and family concerns regarding addiction and tolerance be dispelled at the outset. Cancer pain prevention can be further optimized with the use of appropriate coanalgesics in response to the pathophysiology of the patient's pains. Cognitive and behavioral therapies may also be useful adjuncts to reduce both pain and suffering. Procedure-oriented pain control should be considered when systemic pharmacologic therapy does not provide adequate pain relief or is associated with intolerable side effects. The only absolute contraindications for pain-relieving procedures are untreatable coagulopathy and a decrease in mental status not related to medical pain management. Useful neurodestructive techniques include radiofrequency lesioning, cryoanalgesia, and chemical neurolysis with agents such as phenol, alcohol, and hypertonic saline. The most beneficial pain-relieving procedures and percutaneous cordotomy, spinal narcotics, celiac and hypogastric plexus ablation, spinal neurolysis, and epidural injection of steroids and hypertonic saline. Procedure selection depends on the cause of the pain and the patient's prognosis. Common indications for pain-relieving procedures include unilateral pain below the shoulder, upper abdominal visceral pains, pelvic visceral pain, perineal pain, vertebral body metastasis, discogenic pain, and spinal stenosis. As results of well-conducted scientific trials begin to appear in the literature, the indications for these procedures will be better understood, resulting in their more appropriate use. Principles of nutritional support in patients with cancer include an awareness of the problem of malnutrition and its impact on performance status, quality of life, prognosis, and treatment; identification of those patients at risk; prophylactic versus therapeutic intervention; and analysis and management of the specific impediment(s) to adequate nutrient intake and absorption. The primary goals for nutritional support in cancer patients are prevention of weight loss and maintenance of adequate protein status. Appreciation of practical issues of nutritional support will enable the practicing physician to achieve these goals using primarily oral nutrition options.(ABSTRACT TRUNCATED AT 400 WORDS)

Analgesics, Opioid↗
PubMed2003

Spinal cord stimulation for intractable vulvar pain. A case report.

BACKGROUND: Vulvodynia is a complex pain syndrome with few effective treatments. We present a case of complex persistent vulvar pain effectively managed with spinal cord stimulation. CASE: A 21-year-old woman had a long history of burning vulvar pain exacerbated by exercise and sexual intercourse. Her symptoms began after termination of pregnancy and were not improved by diet changes or medical therapy. A partial vulvar vestibulectomy with Bartholin gland excision was performed, without an improvement. After referral to a pain management specialist, the patient had temporary relief of symptoms following bilateral hypogastric plexus blocks. With these favorable but temporary results, a permanent spinal cord stimulator was implanted, with sustained symptom relief. CONCLUSION: Spinal cord stimulation may offer a new treatment for women with intractable neuropathic vulvar pain.

Adult↗
PubMedDate not supplied

Histotopographic study of the rectovaginal septum.

The rectovaginal septum (RVS) is described as a strong connective tissue between the rectum and the vagina. The aim of the present study was to investigate the topography and histological structure of the RVS in 20 cadavers (age range: 54-72 years). After in situ formalin fixation, the pelvic viscera and the surrounding connective tissue were removed, together with the pelvic floor. In 8 cases, the topographical relationships of the septum with the vagina and rectum were studied during dissection. In 8 other cases, serial macrosections of the bladder base, vagina, lower rectum and pelvic floor complex were stained with hematoxylin-eosin, azan-Mallory and Weigert Van Gieson. RVS thickness was evaluated on transverse sections collected at the cranial and caudal levels of the middle third of the vagina (level II) and inferior third (level III). In the other 4 cases, specimens were cut with a slicer in 2-3 mm thick axial slices and plastinated using the von Hagens E12 technique. The RVS is located in an oblique coronal plane, close to the posterior vaginal wall, and is formed of a network of collagen, elastic fibres, smooth muscle cells with nerve fibres, emerging from the autonomic inferior hypogastric plexus, and variable numbers of small vessels. The RVS was thicker at cranial levels II and III, with respect to caudal level II, both in the midline (1.75 and 1.70 vs 0.2 mm, p<0.05) and lateral portions of the septum (2.67 and 2.64 vs 0.17 mm, p<0.05). At caudal level II, there was no statistically significant difference between the thicknesses of the lateral portions and the midline (0.17 vs 0.2 mm, P>0.05). The RVS resembles an hourglass, with a flattened central portion in the frontal plane. Given its position in the centre of the pelvis, the RVS plays a connecting role between the perineal body and the overlying portions of the endopelvic fascia, and may also play an active role in modulating the tone of the musculature of the pelvic walls during variations in endorectal pressure.

Adipose Tissue↗
PubMed1991

[Studies on retroperitoneal lymph node dissection concerning postoperative ejaculatory function in patients with testicular cancer].

This study was done to explore the appropriate procedure of retroperitoneal lymph node dissection (RLND) to preserve ejaculatory function. The relation between postoperative ejaculatory function and area dissected at RLND was investigated in 47 patients with testicular cancer. The patients were divided into 5 groups according to the retroperitoneal area dissected. Group 1 (38 patients) underwent bilateral RLND, group 2 (3 patients) and 3 (2 patients) right unilateral RLND, and group 4 (2 patients) and 5 (2 patients) left unilateral RLND. The vertical limits of the dissected area were similar in all groups, namely renal pedicle and bifurcation of common iliac artery. The lateral limits were bilateral ureters in group 1, right border of aorta and right ureter in group 2, left border of aorta and left ureter in group 4, and vena cava and left ureter in group 5. Group 3 was similar to group 2, but the paraaortic region at the root of inferior mesenteric artery was also dissected. All patients in group 1 had dry ejaculation. Thirty patients in this group were examined for seminal emission and none of them could demonstrate seminal emission. Normal antegrade ejaculation was seen in group 2 and 4 patients, but retrograde ejaculation was recognized in group 3. Inability of seminal emission ws confirmed in group 5 patients. When consideration is given to the function of retroperitoneal sympathetic nerves, our results suggest that unilateral RLND without impairing superior hypogastric plexus should be adopted to preserve ejaculatory function.

Adolescent↗
PubMedDate not supplied

[Mesorectal resection in oncologic surgery].

A surgical technique to "en bloc" resect the mesorectum while performing an anterior resection is here described. The procedure aims at preserving those nerves whose injury is responsible for a series of neurological sequalae, which affect the patient's quality of life. Fifteen dissections were carried out in order to demonstrate the possibility to perform an accurate mesorectal lymphadenectomy while preserving, in most cases, the nervi erigentes and, in some cases, the hypogastric plexus.

Erectile Dysfunction↗
PubMed1988

[The innervation of the external urethral sphincter muscle].

Innervation of external urethral sphincter muscle was examined in 100 human fetuses and 10 adults of both sexes. Examined nerves take place from deep perineal nerve (branch of pudendal nerve) and, probably, from pelvic splanchnic nerves (via inferior hypogastric plexus). However, this supposition needs further microscopic research. It is also concluded that pelvic splanchnic nerves and pudendal nerve arise from the same ventral branches of spinal nerves (S2-S4).

Adult↗
PubMed1987

[The anatomy of erection].

The authors review the current knowledge concerning the anatomy of erection. The nervi erigentes pass through the hypogastric plexus, travel along the cavernous nerve and terminate in the smooth muscle of the erectile bodies. There appears to be three types of nerves: adrenergic nerves, cholinergic nerves and non-adrenergic, noncholinergic nerves. The arterial blood supply is derived from branches of the internal pudendal artery. The venous drainage occurs via the circumflex veins towards the deep dorsal vein of the penis. The corpus cavernosum is composed of a thick, extensible albuginea which contains an extensible vascular network surrounded by smooth muscle tissue, which, when it contracts, appears to induce detumescence and, when it relaxes, appears to allow inflow of blood into the erectile bodies.

Humans↗
PubMed1986

Sexual and bladder dysfunctions following surgery for rectal carcinoma.

A series of 475 patients who underwent surgery for rectal carcinoma were followed up and entered this study. Sexual and bladder function before and after surgery with respect to the surgical procedure was considered. 221 patients gave suitable information about their urinary function: bladder dysfunction was observed in 20% of amputated patients as against 13-14% of resected patients. 144 patients (103 males and 41 females) were available for a follow-up study of the sexual function. Sexual intercourse, libido, erection, ejaculation, dyspareunia, vaginal humidification, orgasm were the parameters examined. Almost all of them were more affected after abdominoperineal resection than after low anterior resection with manual or stapled anastomosis, although the difference was not always significant. In a few instances the rates were inverted. It is believed that these dysfunctions are not related to the type of surgery, but to required extent of radicality. Extreme care should be always taken when dissecting the end portion of the rectum to avoid injuries to the hypogastric plexus and the pudendal nerve.

Ejaculation↗
PubMed1984

[Experimental studies of the localization of neural centers in the ovaries and fallopian tubes in cows].

For the studies 4 sexually mature cows were used, in which ovaria and oviducts were cut out bilaterally or unilaterally. The fourth cow was the control of the experiment. The operated animals were kept alive for 21 days and then slaughtered. For studies were taken: the brain stem, spinal cord from the segments Th9 - Th13 and L1 - S4, bilateral spinal ganglions, bilaterally the sympathetic chain from the segment Th10 - S4, and also ganglions and visceral-plexi, anterior mesenteric, intermesenteric, posterior mesenteric, hypogastric and pelvic. The material was fixed in alcohol, embedded in paraffin and cut into 15 micron sections. The sections were stained by Nissel's method. For examinations subsequent sections were taken. Due to the operations performed degeneration changes occurred in nervous cells in the central and peripheral nervous system. They were the basis for determination of the localization of the nervous centres for ovarium and oviduct. The source of preganglionic sympathetic visceromotor fibres for these organs is nucleus intermediolateralis in the segment L2 - L3. The sympathetic postganglionic fibres originate from cells of the sympathetic chain from L1 to L3 and from the posterior mesenteric ganglion and hypogastric plexus. The source of parasympathetic fibres for ovarium and oviduct are cells of nucleus parasympathicus nervi vagi in the segment located somewhat posteriorly from obex. The source of viscerosensory fibres for the discussed parts of the sexual organs in the cow are cells of the spinal ganglions in the segment Th9 - Th13 and cells of nucleus tractus spinocerebellaris dorsalis localized in neuromers L2 and L3.

Animals↗
PubMed1981

The role of morphological and functional changes in adrenergic nerves for the development of colchicine-induced supersensitivity in the rat vas deferens.

Local application of colchicine to the hypogastric plexus produced degenerative changes in about 40% of adrenergic nerve endings and a decrease in the neuromuscular transmission in the rat vas deferens. Unlike after denervation, both decreases in the number of normal nerve terminals and neuromuscular transmission induced by colchicine were incomplete and reversible. Although the time course of these changes was apparently related to that of the development of supersensitivity after colchicine treatment, the degeneration of adrenergic nerves does not seem to be an essential factor for the manifestation of colchicine-induced supersensitivity which is quantitatively and qualitatively identical to that induced by denervation. It is suggested that some neurotrophic factor(s) may contribute to the control of responsiveness of the smooth muscle and that the denervation-like supersensitivity is induced by colchicine through an interference of axonal transport in adrenergic nerves.

Animals↗
PubMed1996

[Complications of radical hysterectomy during management of stage Ib and IIa cervix uteri cancer. Experience with 145 patients].

Perioperative morbidity and mortality were studied in 145 patients who underwent radical hysterectomy wit pelvic lymphadenectomy, as treatment of choice for cervical cancer, stages Ib and IIa at The Oncology Service on The General Hospital of México, SSA, with special emphasis in urinary complications when superior bladder arteries were preserved, (99 cases) or not, (46 cases). There was no operative death. There were 20, (13.7%) intraoperative complications: 10 (6.8%) injuries to hypogastric plexus; 5 (3.4%) ureteral sections and 2 (1.3%) injuries to iliac veins. Thirty nine patients, (26.8%) developed postoperative complications, (1 to 30 days): Bladder dysfunction, 30 (20.6%); wound infection, 5 (3.4%); ureterovaginal fistula, 3 (2.0%) and vesicovaginal fistula, 3 (2.0%). After 30 days, we observed 5 complications, (3.4%): ureterovaginal fistula, 3 (2.0); bowel obstruction, 1 (0.6%) and lymphocyst, 1 (0.6%). Surgical time was an hour longer, (4.15 hs vs. 3.15 hs) and bleeding increased a little bit, (1,125 c.c. vs. 980 c.c.) when superior bladder arteries were preserved. However, in these cases, there were less postoperative complications, (29/99, 29.2% vs. 19/46, 41.3%; P < 0.05), including ureterovaginal fistula, (1/99, 1.0% vs. 5/46, 10.8%).

Adenocarcinoma↗
PubMed1984

[Sexual function after vascular surgical interventions in the aortoiliac area--causes and the avoidance of impotence].

Neurogenic and vasculogenic impotence after aortoiliac reconstruction is an unpleasant problem in vascular surgery. The importance of maintaining or restoring intraoperatively a sufficient hypogastric artery blood flow is emphasized. Postoperative neurogenic sexual disabilities are irreversible and are due to interruption of sympathetic nerve fibers supplying the genital system. Dissecting the terminal aorta and the iliac arteries the hypogastric sympathetic plexus--which descends across the bifurcation--can be easily damaged. This is the cause of the high incidence of failure of ejaculation after aortoiliac surgery. In order to avoid this neurogenic sexual dysfunction a retromesenteric approach to the aortoiliac region is anatomically suggested by A. v. Hochstetter. It enables the exposure of the abdominal aorta and the iliac arteries without disrupting the superior hypogastric plexus and its variants. Respecting the integrity of the sympathetic plexus and a sufficient flow in the internal iliac artery the frequency of postoperative disturbances of erection was reduced from 17% (1199 patients) to 12.3% (570 patients). The incidence of postoperative loss of ejaculation in the same groups of patients decreased from 81% to 20%.

Aorta, Abdominal↗
PubMed1999

Visualization of nitric oxide formation in cell cultures and living tissue.

We have visualized nitric oxide (NO) released from cell cultures and living tissue. NO was visualized by a reaction with luminol and hydrogen peroxide to yield photons which were counted using a microscope coupled to a photon counting camera. Murine macrophages were activated with interferon-gamma (IFN-gamma) and endotoxin (LPS). Cultured endothelial cells were stimulated with bradykinin, and neurones in the guinea-pig myenteric plexus and the rabbit hypogastric nerve trunk were electrically stimulated. There was a marked increase in photons emitted from the cultured cells as well as from the living tissues during stimulation. The stimulation-induced photon emission was markedly reduced by inhibition of nitric oxide synthase (NOS); removal of L-arginine from the medium also decreased photon counts. The present method allowed integration times in the order of minutes to improve signal-to-noise ratio. However, the high sensitivity of this method also makes it possible to generate an image in seconds, allowing the production of real time films. Photon emission was enhanced under conditions known to increase NO production, and diminished in the presence of NO inhibitors. Thus, this method has demonstrated specificity for the L-arginine:NO pathway from a wide range of biological sources such as cultured cells and living tissues, and has the potential for real time imaging of NO formation, with high temporal and spatial resolution.

Animals↗