The pterygopalatine ganglion, palatine nerves and vessels: dissection and pathway / El ganglio pterigopalatino, nervios palatinos y vasos: disección y trayecto

SUMMARY: Background and Objectives: The palatine nerves and vessels cross the pterygopalatine fossa, the palatine canals, the palatine foramina and the submucosal space, at the level of the hard palate and the palatine recess of the maxillary sinus. Their trajectory is long, complicated and difficult to highlight on a single dissection piece. In the literature that we studied, we did not find clear images that fully highlight the real configuration of the pterygopalatine ganglion and nerves and of the palatine vessels. Our aim was to provide a clear and representative dissection of the pterygopalatine ganglion and of the palatine neurovascular bundle throughout its pathway in a simple, coherent and useful presentation for the practitioners interested in the regional pathology. We resected the posterior and inferomedial osseous walls of the maxillary sinus and highlighted the neurovascular structures in the pterygopalatine fossa and the wall of the maxillary sinus. We photographed the dissection fields and detailed the important relations. The images that we obtained are clear, simple and easy to interpret and use. We successfully highlighted the aspect and the main relations of the pterygopalatine ganglion and the pathway and distribution of the palatine nerves and vessels, from their origin to the terminal plexuses. There is a broad spectrum of clinical procedures or situations that require a proper knowledge and understanding of the anatomical pathway and relations of the palatine neurovascular elements. This includes the various types of regional anesthesia, tumor resection surgery, flaps of the palatine mucosa, the LeFort osteotomy etc. Demonstration of the pterygopalatine ganglion and its relations is useful in endoscopic interventions at the level of the pterygopalatine fossa.

RESUMEN: Los nervios y vasos palatinos atraviesan la fosa pterigopalatina, además de los canales palatinos, los forámenes palatinos y el espacio submucoso a nivel del paladar duro y el receso palatino del seno maxilar. Su trayectoria es larga, complicada y difícil de destacar en una sola pieza de disección. En la literatura que estudiamos, no encontramos imágenes claras que resalten completamente la configuración real del ganglio y los nervios pterigopalatinos y de los vasos palatinos. Nuestro objetivo fue proporcionar una disección clara y representativa del ganglio pterigopalatino y del haz neurovascular palatino a lo largo de su trayecto en una presentación simple, coherente y útil para los médicos interesados en la patología regional. Resecamos las paredes óseas posterior e inferomedial del seno maxilar y resaltamos las estructuras neurovasculares en la fosa pterigopalatina y la pared del seno maxilar. Fotografiamos los campos de disección y detallamos las relaciones importantes. Las imágenes que obtuvimos son claras, sencillas y de fácil interpretación. Resaltamos con éxito el aspecto y las principales relaciones del ganglio pterigopalatino y el trayecto y distribución de los nervios y vasos palatinos, desde su origen hasta los plexos terminales. En conclusion, existe un amplio espectro de procedimientos o situaciones clínicas que requieren un adecuado conocimiento y comprensión del trayecto anatómico y las relaciones de los elementos neurovasculares palatinos. Esto incluye los distintos tipos de anestesia regional, cirugía de resección tumoral, colgajos de mucosa palatina, osteotomía de LeFort, etc. La demostración del ganglio pterigopalatino y sus relaciones es útil en intervenciones endoscópicas a nivel de la fosa pterigopalatina.

Sphenopalatine ganglion block for relieving postdural puncture headache: technique and mechanism of action of block with a narrative review of efficacy

The sphenopalatine ganglion (SPG) is a parasympathetic ganglion, located in the pterygopalatine fossa. The SPG block has been used for a long time for treating headaches of varying etiologies. For anesthesiologists, treating postdural puncture headaches (PDPH) has always been challenging. The epidural block patch (EBP) was the only option until researchers explored the role of the SPG block as a relatively simple and effective way to treat PDPH. Also, since the existing evidence proving the efficacy of the SPG block in PDPH is scarce, the block cannot be offered to all patients. EBP can be still considered if an SPG block is not able to alleviate pain due to PDPH.

Sphenopalatine ganglion pulsed radiofrequency treatment in patients suffering from chronic face and head pain / Tratamento com radiofrequência pulsada para gânglio esfenopalatino em pacientes com dor crônica de face e cabeça

PURPOSE: There are various facial pain syndromes including trigeminal neuralgia, trigeminal neuropathic pain and atypical facial pain syndromes. Effectiveness of the pulsed radiofrequency in managing various pain syndromes has been clearly demonstrated. There are a limited number of studies on the pulsed radiofrequency treatment for sphenopalatine ganglion in patients suffering from face and head pain. The purpose of this study is to evaluate the satisfaction of pulsed radiofrequency treatment at our patients retrospectively. METHODS: Infrazygomatic approach was used for the pulsed radiofrequency of the sphenopalatine ganglion under fluoroscopic guidance. After the tip of the needle reached the target point, 0.25-0.5 ms pulse width was applied for sensory stimulation at frequencies from 50 Hz to 1 V. Paraesthesias were exposed at the roof of the nose at 0.5-0.7 V. To rule out trigeminal contact that led to rhythmic mandibular contraction, motor stimulation at a frequency of 2 Hz was applied. Then, four cycles of pulsed radiofrequency lesioning were performed for 120 s at a temperature of 42 °C. RESULTS: Pain relief could not be achieved in 23% of the patients (unacceptable), whereas pain was completely relieved in 35% of the patients (excellent) and mild to moderate pain relief could be achieved in 42% of the patients (good) through sphenopalatine ganglion-pulsed radiofrequency treatment. CONCLUSION: Pulsed radiofrequency of the sphenopalatine ganglion is effective in treating the patients suffering from intractable chronic facial and head pain as shown by our findings. There is a need for prospective, randomized, controlled trials in order to confirm the efficacy and safety of this new treatment modality in chronic head and face pain.

OBJETIVO: Existem várias síndromes de dor facial, incluindo neuralgia trigeminal, dor neuropática trigeminal e síndromes atípicas de dor facial. A eficácia da radiofrequência pulsada (RFP) para o manejo de várias síndromes de dor foi claramente demonstrada. Há um número limitado de estudos sobre o tratamento com RFP para gânglio esfenopalatino (GEP) em pacientes que sofrem de dor facial e de cabeça. O objetivo deste estudo foi avaliar a satisfação do tratamento com PRF em nossos pacientes, retrospectivamente. MÉTODOS: A abordagem infrazigomática foi usada para a RFP do GEP sob orientação fluoroscópica. Depois de a ponta da agulha atingir o ponto alvo, pulsos de 0,25 a 0,5 ms foram aplicados para a estimulação sensorial em frequências de 50 Hz a 1 V. Parestesias foram expostas no teto do nariz em 0,5 a 0,7 V. Para excluir o contato trigeminal que levou à contração mandibular rítmica, a estimulação motora foi aplicada na frequência de 2 Hz. Em seguida, quatro ciclos de RFP foram feitos durante 120 segundos a uma temperatura de 42 °C. RESULTADOS: O alívio da dor não foi obtido em 23% dos pacientes (inaceitável); enquanto a dor foi totalmente aliviada em 35% dos pacientes (excelente) e o alívio de leve a moderado da dor foi obtido em 42% dos pacientes (bom), com o tratamento RFP-GEP. CONCLUSÃO: RFP para GEP é eficaz no tratamento de pacientes que sofrem de dor crônica intratável, facial e de cabeça, como mostrado por nossas descobertas. Estudos prospectivos, randômicos e controlados são necessários para confirmar a eficácia e segurança dessa nova modalidade de tratamento para dor crônica facial e de cabeça.

The Sympathetic and Parasympathetic Contributions to the Cardiac Plexus: a Fetal Study / Contribuciones Simpáticas y Parasimpáticas al Plexo Cardíaco: Estudio Fetal

The cardiac plexus is formed by sympathetic nerves originating from the superior, middle, inferior cervical or cervicothoracic ganglia as well as from the first to the fifth thoracic ganglia. Furthermore, the vagus nerve and its counterpart, the recurrent laryngeal nerve supply the cardiac plexus with parasympathetic cardiac nerves. This investigation aimed to review and record the medial contributions of the cervical ganglia, first to fifth thoracic ganglia and medial contributions of the vagus and recurrent laryngeal nerves to the cardiac plexus. The study involved bilateral micro-dissection of forty cadaveric fetal specimens (n=80). The origins of sympathetic contributions to the cardiac plexus were described as either ganglionic, inter-ganglionic or from both the ganglion and the inter-ganglionic sympathetic chain. The number of cervical sympathetic ganglia varied from two to five in this study; the superior cervical ganglion was constant while the middle cervical, vertebral, inferior cervical or cervicothoracic ganglia were variable. The prevalence of cardiac nerves were as follows: superior cervical cardiac nerve (95%); middle cervical cardiac nerve (73%); vertebral cardiac nerve (41%); inferior cervical cardiac nerve (21%) and cervicothoracic cardiac nerve (24%). This investigation records the thoracic caudal limit of the thoracic sympathetic contributions to the cardiac plexus as the T5 ganglion. The findings of this study highlight the importance of understanding the medial sympathetic contributions and their variations to the cardiac plexus as this may assist surgeons during minimal access surgical procedures, sympathectomies, pericardiectomies and in the management of diseases like Raynaud's Phenomenon and angina pectoris.

El plexo cardíaco está formado por los nervios simpáticos procedentes de los ganglios cervicales superior, medio e inferior o cervicotorácico, así como los ganglios torácicos desde el primero al quinto. Por otra parte, el nervio vago y su contraparte, el nervio laríngeo recurrente suministra al plexo cardíaco nervios cardíacos parasimpático. Esta investigación tuvo como objetivo revisar y registrar las contribuciones mediales de los ganglios cervicales, ganglios torácicos del primero al quinto ganglios y contribuciones mediales de los nervios laríngeos recurrentes y vagos en el plexo cardíaco. Se realizó la micro-disección bilateral de cuarenta especímenes cadavéricos fetales (n = 80). Los orígenes de las contribuciones simpáticas hacia el plexo cardíaco se describen de forma independiente como ganglionar o inter-ganglionar, o desde ambos ganglios y la cadena simpática interganglionar. El número de ganglios simpáticos cervicales varió de dos a cinco; el ganglio cervical superior fue constante, mientras que los ganglios medio-cervical, vertebral, cervical inferior o cervicotorácico fueron variables. La prevalencia de los nervios cardíacos fueron: nervio cardíaco cervical superior (95%); nervio cardíaco cervical medio (73%); nervio cardiaco vertebral (41%); nervio cardíaco cervical inferior (21%) y nervio cardíaco cervicotorácico (24% ). La investigación registró el límite torácico caudal de las contribuciones torácicas simpáticos al plexo cardíaco como el ganglio T5. Los resultados de este estudio muestran la importancia de comprender las contribuciones simpáticas mediales y sus variaciones en el plexo cardíaco, ya que podrían ayudar a los cirujanos durante los procedimientos quirúrgicos mínimanente invasivos, simpatectomías, pericardiectomías y en el manejo de enfermedades como el fenómeno de Raynaud y la angina de pecho.

Clinical effect of sphenopalatine ganglion needling in treating primary trigeminal neuralgia of Liver-yang upsurge syndrome type / 中国结合医学杂志

<p><b>OBJECTIVE</b>To observe the efficacy and safety of sphenopalatine ganglion needling in treating patients with primary trigeminal neuralgia (PTN) of Liver (Gan)-yang upsurge syndrome (LYUS) type.</p><p><b>METHODS</b>Sixty-five PTN patients of LYUS type were assigned by a random number table to two groups and treated by deep-needling (33 patients, DN group) and superficial-needling (32 patients, SN group), respectively. The main-acupoint used for both groups was Xiaguan (ST7) of affected side, on which needle was deeply inserted to reach spheno-palatine ganglion in the DN group, but was inserted conventionally in the SN group; the auxiliary acupoints used were the local points Cuanzhu (BL2), Sibai (ST2), Chengjiang (CV24) of affected side, as well as the remote points, bilateral Hegu (LI4) and Taichong (LR3). The needling was implemented every other day, with electric stimulation applied to all the punctured acupoints for 30 min, 10 days treatment as one therapeutic course. Each patient received 2 courses of needling with 1 week interval in between. The clinical efficacy, pain control and adverse reaction were evaluated and compared after the treatment.</p><p><b>RESULTS</b>Rank-sum test showed that the efficacy in the DN group was significantly better than that in the SN group (Z =2.30, P=0.021); the pain was alleviated in both groups in frequency, intensity and sustained time (evaluated by visual analogue scale) significantly (P<0.01), but deep needling showed a superiority over superficial needling in reducing the frequency and intensity of episode (Z=9.55, Z=5.50, both P=0.00). No adverse reaction occurred during the treatment course of both groups.</p><p><b>CONCLUSION</b>Spheno-palatine ganglion needling is highly effective, safe and reliable for the treatment of PTN.</p>

Study on needling depth and direction from different acupoints to sphenopalatine ganglion / 中国针灸

<p><b>OBJECTIVE</b>To observe and survey the location of Xiaguan (ST 7), "Die'e" and Quanliao (SI 18) on the surface, and the needling depth and direction from the 3 points to sphenopalatine ganglion.</p><p><b>METHODS</b>Fifteen corpses (30 sides) of adult male were fixed by 10% formalin. The lateral areas of face were dissected from the surface to the deep on the 3 acupoints: the electric drill with the kirschner wire punctured towards the sphenopalatine ganglion and extended to the contralateral areas according to different directions of puncturing sphenopalatine ganglion from the 3 acupoints. The corresponding puncturing points of the 3 acupoints were measured by the coordinate location method.</p><p><b>RESULTS</b>(1) Surface location: the distance between Quanliao (SI 18) and "Die'e" was 21 mm and the distance between Xiaguan (ST 7) and "Die'e" was 17 mm; (2) Inserting depth of each point to sphenopalatine ganglion: the depths of Xiaguan (ST 7), "Die'e" and Quanliao (SI 18) were 49.9 mm, 46.9 mm and 46.6 mm, respectively; (3) The coordinate location of the corresponding puncturing points: the puncturing direction of Xiaguan (ST 7) was anterointernal upper corresponding to the area of connecting center between contralateral Taiyang (EX-HN 5) and Tongziliao (GB 1), the distance between the corresponding inserting point of Xiaguan (ST 7) and Sizhukong (TE 23) was 17.6 mm; the puncturing direction of "Die'e" point was posterointernal upper, and the horizontal distance from the corresponding puncture point to the zygomatic arch was 33 mm and the vertical distance from the corresponding puncture point to the eyes' outer canthus was 42 mm; the puncturing direction of Quanliao (SI 18) was posteriointernal upper and the distance between the corresponding inserting point and the area of contralateral parietal tuber, the distance between the corresponding inserting point of Quanliao (SI 18) and the connecting line of bilateral external acoustic pore was 28 mm, the distance between the corresponding inserting point of Quan-liao (SI 18) and the medial line of the head was 62 mm.</p><p><b>CONCLUSION</b>Understanding the surface location, inserting depths and the general puncturing directions of the 3 points can provide basis for puncturing the sphenopalatine ganglion in clinical practice.</p>

Anatomic variation of cranial parasympathetic ganglia

Having broad knowledge of anatomy is essential for practicing dentistry. Certain anatomical structures call for detailed studies due to their anatomical and functional importance. Nevertheless, some structures are difficult to visualize and identify due to their small volume and complicated access. Such is the case of the parasympathetic ganglia located in the cranial part of the autonomic nervous system, which include: the ciliary ganglion (located deeply in the orbit, laterally to the optic nerve), the pterygopalatine ganglion (located in the pterygopalatine fossa), the submandibular ganglion (located laterally to the hyoglossus muscle, below the lingual nerve), and the otic ganglion (located medially to the mandibular nerve, right beneath the oval foramen). The aim of this study was to present these structures in dissected anatomic specimens and perform a comparative analysis regarding location and morphology. The proximity of the ganglia and associated nerves were also analyzed, as well as the number and volume of fibers connected to them. Human heads were dissected by planes, partially removing the adjacent structures to the point we could reach the parasympathetic ganglia. With this study, we concluded that there was no significant variation regarding the location of the studied ganglia. Morphologically, our observations concur with previous classical descriptions of the parasympathetic ganglia, but we observed variations regarding the proximity of the otic ganglion to the mandibular nerve. We also observed that there were variations regarding the number and volume of fiber bundles connected to the submandibular, otic, and pterygopalatine ganglia.

Suppression of nicotinic ACh receptors-mediated currents by activation of Eph/Ephrin-B1 signaling involves Src tyrosine kinase and mitogen-activated protein kinase in ciliary ganglion neurons / 生理学报

Recent studies showed that Eph/Ephrin tyrosine kinase family plays an important role in the development and functional maintenance of the nervous system, but its function in the sympathetic nervous system is still obscure. In the present study, we examined the effect of Eph/Ephrin-B1 signaling on the whole-cell currents mediated by either alpha7 or alpha3-nicotinic acetylcholine receptors (nAChRs) in acutly dissociated ciliary ganglion (CG) neurons. Firstly, we detected the effect of Ephrin-B1 on nAChRs currents. The neurons were randomly divided into control group, Ephrin-B1Fc-treated group that was stimulated by recombinant Ephrin-B1Fc, IgG-treated group, and Ephrin-B1-treated group. Secondly, we studied the regulatory mechanism of Ephrin-B1Fc on nAChRs currents. The neurons were randomly divided into control group, Ephrin-B1Fc-treated group, PP2 (inhibitor of Src tyrosine kinase) or PD98095 (antagonist of mitogen-activated protein kinase)-treated group, Ephrin-B1Fc + PP2 or PD98095-treated group. The results showed that there was no significant difference between the currents in control group, IgG-treated group and Ephrin-B1-treated group, but Ephrin-B1Fc significantly suppressed both alpha3-nAChRs and alpha7-nAChRs-mediated currents (P=0.002, P=0.003). Pretreatment with PP2 or PD98095 could partially rescue the Ephrin-B1Fc-induced suppression of currents mediated by alpha3-nAChRs or alpha7-nAChRs respectively. These results suggest that the Eph/Ephrin-B1 signaling may inhibit alpha3-nAChRs and alpha7-nAChRs-mediated currents on CG neurons, involving Src tyrosine kinase and mitogen-activated protein kinase signaling in the regulation of sympathetic nervous system.

Trigeminal Autonomic Cephalalgia by Neurogenic Palatine Compression: A Clinical Report and Review / Cefalea Autonómica Trigeminal por Compresión Neurogénica Palatina: Reporte de Caso y Revisión

This clinical report presents the evolution of a possible intraoral traumatic trigeminal autonomic cephalalgia simulating a probable cluster headache. A 50-year-old female patient had severe right-hand side pain for 7 years with autonomic signs and symptoms, such as lacrimation, conjunctival injection, rhinorrhoea, nasal congestion, forehead perspiration, myosis and eyelid edema. The episodes of pain lasted 4 or 5 months with 3- or 4-month remission periods between the painful onsets. The headaches presented an episodic pattern (1 to 3 attacks daily) lasting three to six hours. The patient had used five prosthetic sets continuously (24 h) for 20 years and the current prosthesis was 7 years old. Accidentally, after the alleviation of the maxillary denture due to it rested on a marked irritated incisive papilla the symptoms disappear. The patient has been periodically checked over a 5 year period since, without recurrence of her pain and autonomic symptomatology. The possible pathophysiology is discussed.

Se presenta un caso de cefalea autonómica trigeminal que simula una cefalea en cluster probable con potencial origen traumático intraoral. Mujer de 50 años que reportaba dolor derecho de intensidad severa con 7 años de evolución. El dolor se presenta con síntomas vegetativos como epifora, irritación de la conjuntiva ocular, rinorea, congestión nasal, sudoración frontal, miosis y edema palpebral. Los episodios de dolor se presentaban intermitentemente en el año, con duración de 4 a 5 meses y periodos de remisión de 3 a 4 meses. Las cefaleas se presentaban de manera episódica en el día (1 a 3 episodios) que duraban de 3 a 6 horas. Se observa prótesis intraoral en mal estado, con 7 años de realizada. La paciente reporta la elaboración de 5 juegos protésicos hasta la fecha y que usa constantemente en el día y la noche. Accidentalmente, y antes de la remisión a otro especialista, los síntomas desaparecen después del alivio mecánico en la zona anterior de la prótesis, que comprimía e irritaba la papilla incisiva. La paciente ha estado bajo controles periódicos durante 5 años y medio, sin recurrencia de los síntomas. La posible fisiopatología es discutida.

Tumores del sistema paraganglionar / Tumors of the paragangliona system

A pesar de que los paragangliomas pueden ser observados desde la base del cráneo hasta la vejiga o a lo largo de la cadena ganglionar del simpático, sólo constituyen el 0,012 por ciento de todos los tumores diagnóticados y su hallazgo en cualquier región anatómica representa una rareza. El objetivo del presente trabajo es hacer un análisis de tres casos clínicos con diagnótico de paraganglioma vistos en nuestro hospital. De los tres pacientes, uno no fue sometido a cirugía por la localización del tumor, ameritando biopsia e inmunohistoquímica para confirmar el diagnóstico, tras el cual recibió tratamiento paliativo, falleciendo año y medio después del mismo, los otros dos pacientes tras el tratamiento quirúrgico se mantienen asintomáticos. Al diagnóstico de estos tumores como en otros, se llega inicialmente con la experiencia del clínico y su sospecha, como los estudios que permitan documentarios, tras lo cual su tratamiento como el seguimiento es fundamental

Modulatory Role of Adenylyl Cyclase and Protein Kinase A (PKA) in 5-hydroxytriptamine3 Induced Intracellular Calcium Increase in Parasympathetic Neurons of Rat Major Pelvic Ganglia / 대한비뇨기과학회지

PURPOSE: Serotonin has effects on the bladder contraction or urethral sphincter tone. Different subtypes of 5-hydroxytriptamine (5-HT) receptors appear to mediate the effects of serotonin on voiding. 5-HT1 and 5-HT2, metamorphic receptors, are examined well. However 5-HT3, ionotrophic receptors, are not examined well. Pelvic ganglia provide the majority of the innervation of the lower urinary tract. Major pelvic ganglia (MPG) in rats are autonomic ganglia, containing both sympathetic and parasympathetic neurons related with voiding. We examined the modulatory role of adenylyl cyclase (AC) and protein kinase A (PKA) in 5-HT3 induced intra cellular calcium increase in rat MPG. MATERIALS AND METHODS: The regulatory effects by AC and PKA were investigated in a single neuron of male rat major pelvic ganglia using patch clamp and fluorescence Ca2+ measurement techniques. RESULTS: Inward currents were induced by 5-HT (10microM) at only parasympathetic neurons of MPG. MDL7222 (10(-6)M), selective 5-HT3 receptor antagonists, completely abolished the 5-HT induced inward currents. 5-HT (10microM) induced intracelluar increases of calcium. These increases were blocked by an AC inhibitor SQ22536 (2x10(-5M)) and myristoylated PKA inhibitor (10(-7)M). Furthermore, foskolin (10(-6)M), AC activator, augmented the 5-HT induced intracellular calcium increase. CONCLUSIONS: The activation of AC/PKA-dependent pathway could enhance 5-HT3 induced intacellular calcium increase in parasympathetic neurons of rat MPG and these is helpful for the better understanding the mechanisms of the bladder contraction or urethral sphincter tone.

Evidence that urocortin is absent from neurons of the Edinger-Westphal nucleus in pigeons

The Edinger-Westphal nucleus (EWN) is a central preganglionic parasympathetic cell group that gives rise to cholinergic input to the ciliary ganglion, thereby regulating several neurovegetative ocular functions. Recently, the supposed presence of the neuropeptide urocortin (UCN) has been reported in EWN neurons in rodent brain. The purpose of the present study was to examine the distribution of UCN in avian brain and to investigate by immunohistochemical analysis the possible use of this substance as an EWN marker in a non-mammalian class of vertebrates. Brain tissue of pigeons was incubated with a specific antibody against UCN and the results showed labeling of many small neurons, forming a double wing in the dorsal mesodiencephalic transition area. Their size and shape, however, differed from those of EWN neurons, and they were preferentially located rostral to the EWN. Double-label experiments employing an antibody against the enzyme choline acetyltransferase (ChAT) showed that UCN is not localized to the cholinergic cells of the EWN and confirmed the rostral distributionof UCN never overlapping the ChAT+ EWN cells. Taken together, these results suggest that, at least in pigeons, the UCN+ population does not belong to the traditionally defined EWN.

A Case of Ross' Syndrome with Horner's Syndrome

Ross syndreome is a rare peripheral nervous system disorder defined by Adie' tonic pupil, hyporeflexia, and segmental anhidrosis. The pathogenesis is believed to result from damage to the ganglion cells or postganglionic fibers, including sympathetic, parasympathetic and dorsal root ganglion cells. A 46 year-old woman complained of right ptosis and decreased sweating of right face. The pupil showed anisocoria, which was evaluated under the variable conditions and recorded with the pupillography using Infrared Scanning Laser Photography(HRA , Heidelberg engineering, Germany). The neurologic examinations including starch-iodine test demonstrated areflexia of lower limbs and hypohidrosis of right face. The above examinations provided evidences that the sympathetic and parasympathetic ganglion cells or the post ganglionic fibers were involved and the diagnosis of Ross syndrome with Horner syndrome was made.

Distribuiçäo topográfica dos neurônios intracardíacos em feto e recém nascido / Topographic distribution of intracardiacs neurons in fetal and newborn

A fim de possibilitar estudos comparativos do SNAIC, procuramos estabelecer a distribuiçäo topográfica dos neurônios, em coraçöes de feto e recém-nascido, segundo limites anatômicos bem definidos. O trabalho foi dividido em 2 etapas. Na primeira, que foi uma etapa auxiliar, verificamos a distribuiçäo geral das células ganglionares nos átrios e ventrículos e o diâmetro médio dos neurônios em 11 coraçöes. Na segunda analisamos, quantitativamente, em 3 coraçöes, a distribuiçäo topográfica dessas células. Concluímos o seguinte: 1. A inclusäo e cortes seriados de todo ou de grande parte do coraçäo de feto e recém-nascido constituiu metodologia útil para o estudo topográfico e contagem de neurônios intracardíacos. 2. Os neurônios, dispostos em gânglios e ocasionalmente como células isoladas, localizavam-se predominantemente no subepicárdio, menos comumente no miocárdio e, raramente, no subendocárdio. Näo foram observados nas aurículas. 3. As células ganglionares geralmente eram uninucleadas, mas apresentaram, ocasionalmente, até 4 núcleos. 4. O diâmetro neuronal variou com a idade gestacional, característica importante para se estabelecer a metodologia para sua contagem. 5. Das 18 áreas por nós identificadas, duas (áreas 1 e 2) eram mais ricas em neurônios e tinham limites anatômicos bem definidos. 6. A área 1, que inclui o nó SA, apresentou a maior quantidade de neurônios (32 por cento). 7. A área 2 continha aproximadamente 12 por cento da populaçäo neuronal analisada e, por ser pouco extensa, permite contagem neuronal menos trabalhosa que a área 1. 8. A área 18, que inclui o nó AV, era pobre em neurônios.

Estudo anatômico e quantitativo do gânglio pterigopalatino humano. Morfometria e estereologia / Anatomic and quantitative study of the human pterygopalatine ganglion. Morphometry and stereology

The pterygopalatine ganglion is important in the regulation of the intraocular pressure and in the cerebral vasodilatation connected with headache of vascular origin. Four human ganglia were dissected, fixed in formalin and serially sectioned with a 6 microns thickness. The volume of the ganglion was calculated by point-counting and stereological parameters were determined using the test-system M42 with light microscopy. The PG volume was (mean +/- standard error of the mean) 5.6 +/- 0.5 mm3. The volume density of neurons was 51.1% +/- 3.4%, and the unitary volume of the neurons was 41,200.0 +/- 2,250.0 microns. The numerical density was 12,600.0 +/- 677.0 neurons by mm3, therefore approximately 70,560 neurons by ganglion.

Neuronal counting and parasympathetic dysfunction in the hearts of chronically Trypanosoma cruzi infected rats

Dez ratos machos Wistar cronicamente infectados pelas cepas Colombiana, Sao Felipe (12SF), e Y do Trypanosoma cruzi, foram submetidos, apos 8 meses de infeccao, juntamente com dez animais controles, ao teste da resposta bradicardica barorreflexa pela injecao endovenosa de fenilefrina. Seis ratos chagasicos exibiram disfuncao cardiaca parassimpatica, caracterizada pela depressao do indice da resposta bradicardica barorreflexa. Embora o estudo histologico dos coracoes chagasicos mostrasse lesoes dos ganglios atriais, a contagem dos neuronios em cortes seriados, nao apresentou reducao numerica significativa dos mesmos.

Estudo quantitativo em microscopia óptica de luz do gânglio pterigopalatino no rato / Light microscopical quantitative study of the pterygopalatine ganglion in rat

Determinaçoes morfométricas estereológicas foram feitas em microscopia óptica de cortes semifinos de gânglio pterigopalatino (GP) do rato. Os seguintes parâmetros do pericário foram analisados: diâmetro equatorial (D), densidade volumétrica (Vv), densidade da superfície por volume (Sv) e densidade numérica (Nv). Os resultados obtidos do estudo de três animais, foram (média + desvio padrao): D = 23,93 + 6,46 mum; Vv = 53,83 + 7,40 por cento; Sv = 0,173 + 0,026 mum1; Nv (x 10(-5)) = 5,38 + 1,26 mum(-3). Os gânglios parassimpáticos cranianos apresentam variaçoes na mesma espécie, e entre diferentes espécies, quanto ao Nv e o tamanho das células.

[3H]-Acetylcholine release from rat atria in chronic chagasic cardiopathy

Isolated superfused rat atria release [3H]-acetylcholine when depolarized with 57 mM potassium. The depolarization-induced [3H]-acetylcholine overflow was significantly reduced in atria from chronically T. cruzi-infected rats with electrocardiographically characterized cardiopathy. This fact suggests the occurrence of functional alterations of cardiac parasympathetic control in these animals, probably related to cardiac ganglioma cell destruction