Differences in sympathetic nervous system activity and NMDA receptor levels within the hypothalamic paraventricular nucleus in rats with differential ejaculatory behavior / 亚洲男科学杂志(英文版)

Differences in intravaginal ejaculation latency reflect normal biological variation, but the causes are poorly understood. Here, we investigated whether variation in ejaculation latency in an experimental rat model is related to altered sympathetic nervous system (SNS) activity and expression of N-methyl-D-aspartic acid (NMDA) receptors in the paraventricular nucleus of the hypothalamus (PVN). Male rats were classified as "sluggish," "normal," and "rapid" ejaculators on the basis of ejaculation frequency during copulatory behavioral testing. The lumbar splanchnic nerve activity baselines in these groups were not significantly different at 1460 ± 480 mV, 1660 ± 600 mV, and 1680 ± 490 mV, respectively (P = 0.71). However, SNS sensitivity was remarkably different between the groups (P < 0.01), being 28.9% ± 8.1% in "sluggish," 48.4% ± 7.5% in "normal," and 88.7% ± 7.4% in "rapid" groups. Compared with "normal" ejaculators, the percentage of neurons expressing NMDA receptors in the PVN of "rapid" ejaculators was significantly higher, whereas it was significantly lower in "sluggish" ejaculators (P = 0.01). In addition, there was a positive correlation between the expression of NMDA receptors in the PVN and SNS sensitivity (r = 0.876, P = 0.02). This study shows that intravaginal ejaculatory latency is associated with SNS activity and is mediated by NMDA receptors in the PVN.

The anatomy for retroperitoneal laparoscopic splanchnicectomy / La anatomía de la esplacnicectomía laparoscópica retroperitoneal

Greater splanchnic nerves (GSNs) and lesser splanchnic nerves (LSNs) are the dominant nerves in the pain of advanced cancer patients, which provides the base of retroperitoneal laparoscopic splanchnicectomy. We dissected 25 cadavers to provide anatomic basis for the surgery. Most GSNs entered the abdominal cavity close to the medial crus of the diaphragm while most LSNs the middle one. The number of the branch varies from 1 (which was 80 %) ­ 3. The abdominal segment length of LSNs and GSNs was 26 mm and 20 mm respectively. The mean diameter of the nerves was about 2 mm. The laparoscope was put through abdominal wall beneath the 12th rib at the posterior axillary line, best angles and distances for the surgery were 50 ° and 80-110 mm respectively. The anatomic parameters of splanchnic nerves in the abdominal cavity as well as the angle and distance for the retroperitoneal laparoscopic splanchnicectomy and the anatomic landmarks were presented by the study. Besides the advantages of small incision, less pain and quick recovery, the anatomic parameters provided a practicable approach for the retroperitoneal laparoscopic splanchnicectomy.

Los nervios esplácnicos mayores (NEM) y los nervios esplácnicos menores (NEm) son los nervios dominantes en el dolor de los pacientes con cáncer avanzado, que proporciona la base de la esplacnicectomía laparoscópica retroperitoneal. Se disecaron 25 cadáveres para proporcionar base anatómica para la cirugía. La mayoría de los NEM entraron en la cavidad abdominal cerca del pilar medial del diafragma, mientras que la mayoría de los Nem lo hicieron cerca del pilar medio. El número de ramas varía de 1 (que era del 80 %) - 3. La longitud del segmento abdominal de NEm y NEM fue de 26 mm y 20 mm, respectivamente. El diámetro medio de los nervios era de aproximadamente 2 mm. El laparoscopio se colocó a través de la pared abdominal debajo de la 12 costilla en la línea axilar posterior, los mejores ángulos y distancias para la cirugía fueron de 50° y 80-110 mm, respectivamente. Los parámetros anatómicos de los nervios esplácnicos en la cavidad abdominal, así como el ángulo y la distancia para la esplacnicectomía laparoscópica retroperitoneal y los puntos de referencia anatómicos fueron presentados por el estudio. Además de las ventajas de la incisión pequeña, menos dolor y recuperación rápida, los parámetros anatómicos proporcionaron un enfoque práctico para la esplacnicectomía laparoscópica retroperitoneal.

Comparative Study of the Effects of the Retrocrural Celiac Plexus Block Versus Splanchnic Nerve Block, C-arm Guided, for Upper Gastrointestinal Tract Tumors on Pain Relief and the Quality of Life at a Six-month Follow Up

BACKGROUND: The celiac plexus and splanchnic nerves are targets for neurolytic blocks for pain relief from pain caused by upper gastrointestinal tumors. Therefore, we investigated the analgesic effect of a celiac plexus block versus a splanchnic nerve block and the effects of these blocks on the quality of life six months post-intervention for patients with upper GIT tumors. METHODS: Seventy-nine patients with inoperable upper GIT tumors and with severe uncontrolled visceral pain were randomized into two groups. These were Group I, for whom a celiac plexus block was used with a bilateral needle retrocrural technique, and Group II, for whom a splanchnic nerve block with a bilateral needle technique was used. The visual analogue scale for pain (0 to 100), the quality of life via the QLQ-C30 questionnaire, and survival rates were assessed. RESULTS: Pain scores were comparable in both groups in the first week after the block. Significantly more patients retained good analgesia with tramadol in the splanchnic group from 16 weeks onwards (P = 0.005, 0.001, 0.005, 0.001, 0.01). Social and cognitive scales improved significantly from the second week onwards in the splanchnic group. Survival of both groups was comparable. CONCLUSIONS: The results of this study demonstrate that the efficacy of the splanchnic nerve block technique appears to be clinically comparable to a celiac block. All statistically significant differences are of little clinical value.

Spinal Cord Stimulation for Intractable Visceral Pain Due to Sphincter of Oddi Dysfunction

Sphincter of Oddi dysfunction (SOD) is a syndrome of chronic biliary pain or recurrent pancreatitis due to the functional obstruction of the pancreaticobiliary flow. We report a case of spinal cord stimulation (SCS) for chronic abdominal pain due to SOD. The patient had a history of cholecystectomy and had suffered from chronic right upper quadrant abdominal pain. The patient had been diagnosed as having SOD. The patient was treated with opioid analgesics and nerve blocks, including a splanchnic nerve block. However, two years later, the pain became intractable. We implanted percutaneous SCS at the T5-7 level for this patient. Visual analog scale (VAS) scores for pain and the amount of opioid intake decreased. The patient was tracked for more than six months without significant complications. From our clinical case, SCS is an effective and alternative treatment option for SOD. Further studies and long-term follow-up are necessary to understand the effectiveness and the limitations of SCS on SOD.

Inhibitory Effect and Possible Mechanism of Intraurethral Stimulation on Overactive Bladder in Female Rats / 대한배뇨장애요실금학회지

PURPOSE: To investigate the inhibitory effect and possible mechanism of intraurethral stimulation on overactive bladder (OAB) induced by acetic acid irritation. METHODS: Cystometry was performed in 13 urethane-anesthetized female rats. Intravesical infusion of 0.5% acetic acid was used to irritate the bladder and induce OAB. Multiple cystometrograms were performed with mirabegron, continuous stimulation, mirabegron plus continuous stimulation, and beta3-adrenoceptor antagonist plus continuous stimulation to determine the mechanism underlying the inhibitory effect by intraurethral stimulation. RESULTS: Infusion of acetic acid significantly decreased bladder capacity. Intraurethral stimulation at 2.5 Hz plus mirabegron significantly increased bladder capacity and decreased the nonvoiding contraction count. The changes were strongly inhibited after the beta3-adrenoceptor antagonist was administered. CONCLUSIONS: Activation of urethral afferent nerves can reverse OAB, which activates C-fiber afferent nerves. This animal study indicates that intraurethral stimulation may interfere with OAB through hypogastric nerve activation and pudendal nerve neuromodulation.

Composite nerve fibers in the hypogastric and pelvic splanchnic nerves: an immunohistochemical study using elderly cadavers / 대한해부학회지

To determine the proportion of nerve fibers in the hypogastric nerve (HGN) and pelvic splanchnic nerve (PSN), small tissue strips of the HGN and PSN from 12 donated elderly cadavers were examined histologically. Immunohistochemistry for neuronal nitric oxide synthase (NOS), vasoactive intestinal peptide (VIP), and tyrosine hydroxylase (TH) was performed. More than 70% of fibers per bundle in the HGN were positive for TH at the level of the sacral promontory. In addition, NOS- (negative) and/or VIP+ (positive) fibers were observed in small areas of each nerve bundle, although the proportion of each was usually less than 10%. In the PSN near the third sacral nerve root, the proportion of nerve fibers positive for NOS and/or VIP (or TH) was below 30%. In both the HGN and PSN, the number of VIP+ fibers was usually greater than that of NOS+ fibers, with frequent co-localization of NOS and VIP. More fibers in both nerves were positive for TH than for these other markers. In contrast to pelvic plexus branches, there were no differences in the proportions of NOS+ and VIP+ fibers between nerve bundles in each of the tissue strips. Thus, target-dependent sorting of nerve fibers was not apparent in the HGN at the level of the sacral promontory or in the PSN near the third sacral nerve root. The NOS+ and/or VIP+ fibers in the HGN were most likely ascending postganglionic fibers to the colon, while those in the PSN root may be preganglionic fibers from Onuf's nucleus.

Radiofrequency thermocoagulation of the thoracic splanchnic nerve in functional abdominal pain syndrome: A case report / 대한마취과학회지

The thoracic splanchnic nerve block has been used in managing abdominal pain, especially for pains arising from abdominal cancers. A 27-year-old male patient who had a constant abdominal pain was referred to our clinic for pain management but had no organic disease. The numeric rating scale (NRS) for pain scored 7/10. We applied a diagnostic thoracic splanchnic nerve block under the diagnosis of functional abdominal pain syndrome. Since the block reduced the pain, we applied a radiofrequency thermocoagulation at the T11 and T12 vertebral level. Thereafter, his symptoms improved markedly with pain decreasing to an NRS score of 2-3/10. Hereby, we report a successful management of functional abdominal pain via radiofrequency thermocoagulation of the thoracic splanchnic nerves.

Comparison between CT-scan and trans-abdominal sonography in celiac and splanchnic plexus blocks in patients with advanced pancreatic head cancer

Malignant diseases are usually associated with severe pain during their course especially at the end stages. Pancreatic head cancer is one of these diseases which can be associated with severe intolerable pains in the end stages. Sometimes, these pains are extremely severe and interfere with patient's normal life. There are various techniques to control the pain out of which, celiac and splanchnic plexus blocks [temporary and permanent] are widely accepted procedures especially in severe cases and can control the pain efficiently. There are different approaches for performing this block which are all acceptable technically but are different in case of efficacy, accuracy and potential complications. Two groups were studied prospectively in 3 academic centers to evaluate different techniques of celiac plexus block in terms of feasibility and complications. For this purpose, 61 patients with a confirmed pancreatic head cancer who experienced severe pains were divided into two groups. CT- and sonographically-guided celiac and splanchnic plexus blocks were evaluated in group 1 [n=32] and group 2 [n=29], respectively. This study showed that the pain control and patients' satisfaction were greater in the CT-scan group [group A, p=0.18]. The success rate of performing a ganglion block was higher in the ultrasound group [group B, p=0.000]. The need for a re-block was also higher in the latter group. But, the quality of life improved more in the first group [CT-scan group]. However, no statistically significant difference was found between the two groups regarding these two variables. Pain relief started earlier and lasted longer in the CT-scan group. No complication was detected except for one case of abdominal infection in the sonography group and in some cases a mild pain [score<3] was reported which was not significant. Considering the limited number of cases, it seems that although there was no significant difference in the outcome of plexus block or related complications between the two above-mentioned procedures, the suggested imaging technique for celiac plexus block is CT-scan because of its feasibility, accuracy and lower number of trials to achieve a favorable result. More complementary assessments are recommended to obtain more precise results

Origin, Trajectory and Relationships of the Major Splancnic Nerve / Origen, Trayecto y Relaciones del Nervio Esplácnico Mayor

The major splancmc nerve is part of the nervous simpathic system and is placed in the posterior mediastine heading for the abdomen to innerve the abdominal visceras, and it's anatomical knowledge is of great importance to surgical procedures on this region. A descriptive anatomical study aimed to study the origin, trajectory and relationship of the major splancnic nerve. 44 nerves from 22 adult bodies, from both sex, from no defined race and maintained in formol at 10% were dissected. Many ways of origins to the splacnic nerve were observed, with only 7 cases being concordant with the researched authors. There were 25 nerves (56%) made from non sequenced origins. From the right nerves, 14 (63,8%) from the 22 cases originated from three or four roots from the simpathic trunk. In 12 (54,5%) left nerves, two or three contributions from the simpathic range were predominant. 22 nerves (16 from the right and 6 from the left) followed the descendant rout on the medial way and 22 nerves (6 from the right and 16 from the left) headed down following the spine side outline with no medial return. 21 nerves were found (6 from the right and 15 from the left) in a lateral location to the thoracic spine, 16 front-lateral nerves (9 from the right and 7 from the left) and 7 right nerves were anterior to the spine. We concluded there's no origin standard to the major splancnic nerve due to its large variety of origins. The major splancnic nerve may be placed in front to the thoracic spine after it's formation. Therefore, it's expected that this study may enlarge knowledge about the major splancmc nerve and reduce the risks caused by its damage in surgical procedures in the posterior mediastine.

El nervio esplacnico mayor es parte del sistema nervioso simpático y se ubica en el mediastino posterior, se dirige hacia el abdomen para inervar las visceras de la región. Su conocimiento anatómico es de importancia en los procedimientos quirúrgicos que se realizan en el abdomen. Este trabajo tuvo como objetivo estudiar el origen, trayecto y relaciones del nervio esplacnico mayor Fueron disecados 44 nervios de 22 cadáveres adultos, formolizados al 10%, de ambos sexos de diferentes razas. 25 nervios (56%) no tenían un origen secuencial. En el lado derecho, 14 casos (63,8%) se originaron a partir de tres o cuatro raíces del tronco simpático. En el lado izquierdo, en 12 casos (54%), el rango de contribución simpática predominante fue de dos o tres raíces. 22 nervios (16 del lado derecho y 6 del izquierdo) siguieron su descenso medialmente y los restantes 22 nervios (6 del lado derecho y 16 del izquierdo) se dirigieron caudalmente siguiendo la columna vertebral, contorneándola lateralmente sin dirigirse hacia medial. Se encontraron 21 nervios (6 del lado derecho y 15 del izquierdo) en una ubicación lateral a la columna vertebral torácica, 16 nervios en una ubicación anterolateral (9 del lado derecho y 7 del izquierdo) y 7 nervios derechos ubicados anterior a la columna vertebral. Concluimos que no hay un origen estándar del nervio esplacnico mayor . El nervio esplacnico mayor puede ubicarse anterior a la columna vertebral luego de su formación. Se espera que este estudio contribuya al conocimiento del nervio esplacnico mayor y así reducir el riesgo causado por daños en los procedimientos quirúrgicos realizados en el mediastino posterior.

Thoracoscopic splanchnicectomy for pain control in irresectable pancreatic cancer

Disabling pain of many patients with irresectable pancreatic cancer is poorly managed and can remain a significant problem until their deaths. The aim of this study was to evaluate the safety and efficacy of thoracoscopic splanchnicectomy for pain control in patients with irresectable pancreatic cancer. Thirty patients suffering from intractable pain due to irresectable pancreatic cancer underwent 15 attempted thoracoscopic splanchnicectomy procedures. All patients were opiate dependent. Right-sided splanchnicectomy was preformed for a dominantly right-sided pain, whereas a centralized bilateral, or left-sided pain was managed by left splanchnicectomy. If pain recurred, patients were offered to have the procedure repeated on the contralateral side. Thoracoscopic splanchnicectomy procedure was a technical failure because of pleural adhesions in one patient. Fourteen [10 left-and 4 right-sided] thoracoscopic splanchnicectome were successfully completed in 12 patients. Immediate pain relief was achieved in all 12 patients after unilateral thoracoscopic splanchnicectomy. Pain relief persisted till death in 8 patients and till latest postoperative follow-up visit at 5 months in one patients. Two patients required a contralateral procedure for pain recurrence. A third patient had a recurrent pain but refused contralateral intervention. Eoccept the later, non of me patients requiredopioids. Thoracoscopic splanchnicectomy is a safe, simple, and effective minimally invasive procedure. It offers a substantial relief of pain in patients with unresectable pancreatic cancer

Precise Anatomical Location of the Autonomous Nerve from the Pelvic Plexus to the Corpus Cavernosum / 대한비뇨기과학회지

PURPOSE: We wanted to study the precise anatomical location of the branches of the pelvic plexus from the sacral root to the cavernous nerve. MATERIALS AND METHODS: We performed microdissection on the pelvises from 4 male formalin fixed cadavers under a Zeiss surgical microscope and we traced the location of the branches of the pelvic plexus at a magnification of 6x. RESULTS: The configuration of the pelvic plexus was an irregular diamond shape rather than rectangular. It was located retroperitoneally on the lateral wall of the rectum 8.2 to 11.5cm from the anal verge. Its midpoint was located 2.0 to 2.5cm from the seminal vesicle posterosuperiorly. A prominent neurovascular bundle (NVB) was located on the posterolateral portion of the apex and the mid portion of the prostate. The pelvic splanchnic nerve (PSN) joined the NVB at a point distal and inferior to the bladder-prostate (BP) junction. The PSN components joined the NVB in a spray-like distribution at multiple levels distal to the BP junction. The distance from the membranous urethra to the NVB was 0.5 to 1.2cm. We also found multiple tiny branches on the anterolateral aspect of the prostate apex. CONCLUSIONS: In contrast to the usual concept, the NVB was much wider above the mid portion of the prostrate and it supplied multiple tiny branches on the anterolateral aspect of the prostate. The PSN branches arose from the more posteroinferior area of the pelvic plexus. Therefore, we recommend a more anterior dissection of the lateral pelvic fascia for nerve sparing radical prostatectomy. If surgeons plan a nerve graft after radical prostatectomy, they should consider this neuroanatomy for obtaining a successful outcome.

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.

Videothoracoscopic left splanchnicectomy in a patient with intractable pain due to advanced pancreatic cancer

Severe upper abdominal pain is a dominant and distressing feature of advanced pancreatic cancer. We performed videothoracoscopic left splanchnicectomy in a patient with intractable upper abdominal pain due to advanced pancreatic cancer. Pain was reduced significantly after the operation and the patient enjoyed consistent pain relief during the postoperative follow-up. The adequacy of the analgesic management improved, the patient did not require opioids. Unilateral left thoracoscopic splanchnicectomy is a simple, minimally invasive, effective, and safe procedure that can be recommended as the method of choice for the management of intractable pain due to advanced pancreatic cancer

Modulation of hormone secretion by functional electrical stimulation of the intact and incompletely dysfunctional dog pancreas

The purpose of the present study was to modulate the secretion of insulin and glucagon in Beagle dogs by stimulation of nerves innervating the intact and partly dysfunctional pancreas. Three 33-electrode spiral cuffs were implanted on the vagus, splanchnic and pancreatic nerves in each of two animals. Partial dysfunction of the pancreas was induced with alloxan. The nerves were stimulated using rectangular, charge-balanced, biphasic, and constant current pulses (200 µs, 1 mA, 20 Hz, with a 100-µs delay between biphasic phases). Blood samples from the femoral artery were drawn before the experiment, at the beginning of stimulation, after 5 min of stimulation, and 5 min after the end of stimulation. Radioimmunoassay data showed that in the intact pancreas stimulation of the vagal nerve increased insulin (+99.2 µU/ml) and glucagon (+18.7 pg/ml) secretion and decreased C-peptide secretion (-0.15 ng/ml). Splanchnic nerve stimulation increased insulin (+1.7 µU/ml), C-peptide (+0.01 ng/ml), and glucagon (+50 pg/ml) secretion, whereas pancreatic nerve stimulation did not cause a marked change in any of the three hormones. In the partly dysfunctional pancreas, vagus nerve stimulation increased insulin (+15.5 µU/ml), glucagon (+11 pg/ml), and C-peptide (+0.03 ng/ml) secretion. Splanchnic nerve stimulation reduced insulin secretion (-2.5 µU/ml) and increased glucagon (+58.7 pg/ml) and C-peptide (+0.39 ng/ml) secretion, and pancreatic nerve stimulation increased insulin (+0.2 µU/ml), glucagon (+5.2 pg/ml), and C-peptide (+0.08 ng/ml) secretion. It was concluded that vagal nerve stimulation can significantly increase insulin secretion for a prolonged period of time in intact and in partly dysfunctional pancreas.

Radiofrequency Thermocoagulation of Splanchnic Nerve in Patients with Upper Abdominal Pain / 대한마취과학회지

The splanchnic nerve block can be an alternative method for the pain control in the upper abdomen, when the celiac plexus block does not work. And the radiofrequency thermocoagulation has benefits over alcohol or phenol block because its effect is more localized and predictable. This report describe two patients with metastatic cancer pain in the abdominal cavity who successfully treated with the splanchnic nerve block by using radiofrequency thermocoagulation.

Membrane electrical properties of visceral nociceptive neurons in anterior cingulate gyrus of cat / 中国应用生理学杂志

<p><b>AIM</b>To explore the cerebral cortex mechanism of visceral nociceptive sensation and its characteristics on the cell level, we investigated the membrane electrical properties of 176 stimulus-relative neurons of greater splanchnic nerve (GSN) in anterior cingulate gyrus (ACG) of 20 adult healthy cats.</p><p><b>METHODS</b>We used intracellular recording techniques of glass microelectrode and injected polarizing current into the neurons in ACG.</p><p><b>RESULTS</b>Among 176 neurons, 148 were visceral nociceptive neurons (VNNs) and 28 non-visceral nociceptive neurons (NVNNs). The membrane resistance (Rm), time constant (tau), membrane capacity (Cm), and the I-V curve of both VNNs and NVNNs in ACG were significantly different. The discharge frequency and amplitude of both VNNs and NVNNs produced by injecting depolarized current were different, too.</p><p><b>CONCLUSION</b>The results suggest that structure of cell membrane, volume of the soma, and other aspects of morphology between VNNs and NVNNs in ACG may have significant differences. The results also might provide progressively experimental evidence for specific theory of pain sensation.</p>

Effect of atropine on the inhibition of melatonin to the unit discharges evoked in the posterior group of thalamic nuclei in cats / 药学学报

<p><b>AIM</b>To study the effect of atropine, muscarinic cholinergic antagonist, on the central analgesic action of melatonin (MT) and to explore the mechanism of MT analgesia.</p><p><b>METHODS</b>As an indicator of visceral pain, the unit discharges of the neurons in the posterior group of thalamic nuclei (PO) were caused by stimulating the great splanchnic nerve (GSN) of the cat. The cranial stereotaxic and extracellular glass microelectrode record technique were used. The drugs were given through the intra-cranial-ventricle (icv).</p><p><b>RESULTS</b>0.1% MT (10 micrograms.kg-1, icv) was shown to inhibit the unit discharge of the neurons in PO of the cat, whether the long latency or the short latency, which was evoked by stimulating GSN. The inhibition of 0.1% MT (10 micrograms.kg-1, icv) on the short latency discharge of neurons in PO was antagonized by 0.1% atropine (20 micrograms, icv). However, 0.1% atropine (20 micrograms, icv) did not show antagonistic effect on the inhibition of 0.1% morphine (5 micrograms, icv) at the same latency.</p><p><b>CONCLUSION</b>MT exhibited central analgesic action with mechanism different from morphine. It was suggested that the cholinergic system may be involved in analgesic process of MT.</p>

Estudo da açäo do extrato de Ginkgo biloba e amido hidroxietílico hipertônico na atenuaçäo de alteraçöes decorrentes de isquemia e reperfusäo de órgäos esplâncnicos em ratos / Study of action of Ginkgo biloba extract and hypertonic hydroxyethyl starch on attenuating of ischemia and reperfusion changes of splanchnic organs in rats

A oclusäo e reperfusäo das artérias esplâncnicas ocasiona choque circulatório, causado principalmente pelo aumento de permeabilidade vascular e pela agressäo celular provocada por radicais livres derivados do oxigênio. Este estudo tem por finalidade verificar a açäo do extrato de Ginkgo biloba (Egb-761) e do amido hidroxietílico (AHH) na prevençäo do choque circulatório produzido pela isquemia e reperfusäo de órgäos esplâncnicos. O Egb-761 tem propriedades antioxidantes relatadas na literatura. O AHH, tem sido utilizado como recurso terapêutico do choque hipovolêmico. Ratos anestesiados receberam infusäo contínua de Egb-761 ou AHH, sendo submetidos à isquemia (oclusäo do tronco celíaco, artéria mesentérica superior e artéria mesentérica inferior por 30 minutos) e reperfusäo (por 90 minutos) dos órgäos esplâncnicos. Foram feitas: análise histopatológica ileal, dosagem de malondialdeído ileal e determinaçäo contínua da pressäo arterial média (PAM). A PAM ao final do período de reperfusäo foi significativamente mais elevada nos animais tratados com Egb-761 e AHH, que no grupo controle (F=18,29; p<0,001). Näo houve diferença entre os grupos tratados e controle quanto à dosagem de MDA (H=4,61; p>0,10) e quanto às alteraçöes histológicas (H=6,003; p>0,10). Em conclusäo, houve melhora nas condiçöes hemodinâmicas, com atenuaçäo do choque nos ratos que receberam Egb-761 ou AHH. Novos estudos seräo necessários para se avaliar melhor as alteraçöes histológicas e para esclarecer a formaçäo de produtos finais da peroxidaçäo lipídica.

Thoracoscopic Splanchnicectomy for the Relief of Intractable Upper Abdominal Cancer Pain

PURPOSE: Pain is the most distressing feature of cancer patients. Thoracoscopic splanchnicectomy, first performed in 1993, has caused a resurgence of interest in surgical treatment of such excruciating pain. We wish to introduce a method of splanchnicectomy. METHODS: Five patients underwent a splanchnicectomy for intractable cancer pain, over a period of 11 months. We evaluated the type of splanchnicectomy performed and the results. The procedure was done using a double lumen catheter to deflate the lung at the operation side under general anesthesia with the patient in the lateral decubitus position. A small opening was made with scissors in the pleura of the 5th intercostal space to expose the terminal branch of the greater splanchnic nerve. Six-Seven branches of splanchnic nerve were cut downward until the splanchnic nerve trunk and then cut. A left thoracoscopic splanchnicectomy was done in one case, and a bilateral thoracoscopic splanchnicectomy in four cases. RESULTS: The splanchicectomy appears to result in significant reduction of abdominal pain in all cases. There were no postoperative complications. CONCLUSION: As a conclusion, thoracoscopic splanchnicectomy is the treatment of choice for intractable intraabdominal cancer pain, affording drug cessation and recovery of daily activity in most patients.