Thoracoscopic Splanchnicectomy for Intractable Abdominal Pain

PURPOSE: In patient with intractable abdominal pain due to cancer, with respect to the quality of life, it is often insufficient to relieve pain with the use of analgesics. The development of laparoscopic surgery has made a thoracoscopic splanchnicectomy possible, but the results by using several different methods have varied between different authors. Herein, we introduce a modified method of thoracoscopic splanchnicectomy on the basis of anatomical background from cadaver dissection. METHODS: Sixteen thoracoscopic splanchnicectomies were performed, with the Numerical rating scale (NRS) used for the assessment of pain. The procedure was performed, under general anesthesia, using a double lumen catheter to deflate the lung on the operation side with the patient in the lateral decubitus position. Openings were made in the 7th intercostal space at the postaxillary line for a 12 mm trocar and in the 4th and 5th intercostals spaces for 5 and 2 mm trocars, respectively. The terminal branch of the greater splanchnic nerve ends In 5th intercostal space. Six or seven branches of the splanchnic nerve were cut, dissected downward to just above the diaphragm and then cut. The sympathetic trunk was also cut in this level if the patient suffered from constipation. RESULTS: A splanchicectomy appeared to result in significant reduction of abdominal pain in all cases. The average reduction in the pain score was 78%. There were no postoperative complications. CONCLUSION: A thoracoscopic splanchnicectomy is the treatment of choice for intractable intraabdominal cancer pain, helping with drug cessation or the reduction and recovery of daily activity in most patients.

The Subscapular Artery and Its Relationship with the Brachial Plexus / 대한해부학회지

The change of arising site of branches from the axillary artery determines it's topographic relationship with the brachial plexus because of closeness between the artery and the plexus. Variation of the subscapular artery (SSA) should be concerned when it is used for the source artery of some flaps, especially focusing on the variation of branching pattern and site of origin and relationships with the brachial plexus. In some cases of absence of SSA, if the circumflex scapular and the thoracodorsal arteries arise from the variable portion of the axillary artery separately, they might change the relationships with the brachial plexus. This study was performed to clarify the relationships between the subscapular artery and the brachial plexus according to the variation of the origin of the SSA and its branch. Two hundred seventeen axillae from 110 Korean cadavers were used for this study. SSA was found in 87.1% of cases, while in 12.9%, the circumflex scapular and the thoracodorsal arteries arose from the axillary artery (AA) seperately. SSA arose most frequently from the third part of the AA (63.6%), and in 4/5 of these cases, it ran behind the radial and ulnar nerves. When it arose from the second part (18.9%) or from the first part (4.6%) of AA, it mostly ran over anterior to the medial cord or/and the ulnar nerve. In 41.9% of the cases, a posterior circumflex humeral artery made a common trunk with the SSA or came from the circumflex scapular artery. In 28.1% of the materials, the SSA made a common trunk with a lateral thoracic artery especially when it arose from the first or second part of AA. After running a mean distance of 2.2 cm from AA, SSA was divided into the circumflex scapular and the thoracodorsal arteies. The SSA gave off the branches to the subscapularis in 68.7% of the cases, and the branches to the serratus anterior in 76.0%.

Morphological Analysis of the Effect of 2, 3, 7, 8-tetrachlorodibenzo-p-dioxin on the Peripheral Nervous System of Mouse / 대한해부학회지

Toxicity of TCDD on the peripheral nerve has not yet been clear even though there are many reports about its toxicity on various organs of human and other animals. This study was designed to clarify the effect of TCDD on the peripheral nerve by the morphometric and electron microscopic analysis. Fourty mg/kg of TCDD was injected to 4 week-old C57BL/6J mice intraperitoneally. At the 1st, 4th and 16th weeks after TCDD injection, the 4th lumbar segments of the spinal cord, the same level of spinal ganglia, and the sciatic nerves were taken. They were used for the light and electron microscopic examination and morphometric analysis. The nerve cell bodies of the anterior horn and the spinal ganglia did not show the difference between the TCDD-treated and control groups. Neuronal population of the ganglia of the TCDD-treated group did not differ from that of the control group. Unusually thickened myelin was frequently observed in the TCDD-treated groups, while axonal degeneration was not found in the sciatic nerves of both groups. The cross sectional area of myelin sheaths in the TCDD-treated group of all age was larger than that of the control group. Under the trasmission electron microscope, the myelin of the TCDD-treated group showed that it lost the regular compact arrangement and its lamellar was disrupted. In conclusion, we suggest that TCDD slows down the nerve conduction velocity via the disruption of the myelin structure of the peripheral nerve.