Search

Objective: To evaluate the feasibility and effectiveness of intraoperative nerve staining by modified leucomethylene blue (MLB)., Methods: Animal experiment was performed to assure whether the tissues dyed blue by MLB were nerves with microscopic examination. Ten patients with cervical cancer were performed by nerve-sparing radical hysterectomy (NSRH) and nerve staining intraoperatively by MLB. The status of staining was recorded. The post-void residual urine volume after removing was measured by ultrasound. The time to post-void residual urine volume of less than 100 ml and the first defecation were recorded., Results: In animal experiment, the tissues dyed blue obviously showed abundant nerve fibers by microscopic examination. The minor nerves were dyed blue clearly in NSRH. The time to post-void residual urine volume of less than 100 ml after removal of the urethral catheter was 10.3 (7-13) days by records. The time to the first defecation was 67.7 (60-82) h., Conclusion: Intraoperative nerve staining by MLB provided a new method for nerve location in NSRH. It was safe, effective and convenient.

Introduction: The objective of the present prospective study was to determine the frequency of pelvic autonomic nerve preservation (PANP) during total mesorectal excision (TME) for rectal carcinoma, and to identify a possible link between PANP and postoperative micturition disturbances., Methods: Between March 1997 and February 2003, 229 patients with adenocarcinoma of the rectum were operated on with sphincter preservation in 178 (78%) cases. In 101 (48%) patients, the tumor did not invade the muscularis propria. To determine influence parameters on the achievement of complete PANP, a multivariate analysis was performed. The number of complete-partial-or nonidentification of the nerves (superior hypogastric plexus up to the neurovascular bundles) was documented and correlated with micturition disturbances., Results: The pelvic autonomic nerves were identified completely in 169 (74%), partially in 25 (11%), and could not be demonstrated in 35 (15%) patients. Multivariate analysis showed multivisceral resection ( p<0.001), gender ( p<0.001), surgeon (<25 operations >, p<0.001), and tumor site (middle/upper third vs lower third of rectum, p= 0.011) to exert an independent influence on the achievement of complete PANP. Twenty (8.8%) patients needed a long-term urinary catheter. Preservation of the parasympathetic nerves was associated with low bladder dysfunction rates (4.1 vs 22.4%, p<0.001)., Conclusions: To minimize the risk of postoperative micturition disturbances due to neurogenic bladder, pelvic autonomic nerves should be identified during TME. Neurogenic bladder after TME is a useful parameter to assess the quality of surgical treatment for rectal carcinoma.

In cardiac transplantation, the donor organ is not initially innervated and demonstrates decreased heart rate variability (HRV). However, HRV may improve after several months. The mechanism for HRV improvement has not been elucidated; autonomic "reinnervation" of the donor heart has been proposed. The role of atrioatrial conduction from recipient to donor organ has not been evaluated. We prospectively evaluated cardiac transplant patients with a limited electrophysiology study at the time of their surveillance biopsies. Recordings were made of recipient and donor signals, observing conduction properties between recipient and donor atria. Holter recordings were analyzed and HRV was determined using spectral analysis techniques, recording mean RR interval, low-frequency power (LF), high-frequency power (HF), and the LF/HF ratio. These were compared to published norms. From November 1999 to May 2000, 21 patients (6 female) who underwent cardiac transplantation participated at a median age of 101 months (range, 4.1-217 months). Time posttransplant ranged from 26 days to 71 months. Holter data were available for 20 patients and demonstrated dissociated P waves in 13 (65%). The mean heart rate on Holter was 111 beats per minute (bpm) (range, 85-161 bpm). We were able to record distinct recipient atrial signals in 16 of 21 (76%) patients. The average recipient tissue heart rate was 55% that of the donor heart rate. We documented atrioatrial association in only 1 patient. HRV did not reach normal values for most patients and did not increase with time posttransplantation. The LF values were in the normal range for most patients, whereas 3 patients had normal HF values and 2 patients had values just below normal. Recipients of heart transplantation have a predominantly sympathetic influence of HRV. These preliminary data suggest that atrioatrial conduction does not play a role in reestablishing normal heart rate control following pediatric cardiac transplantation.

Introduction: Preservation of sexual function and voiding capacity after rectal cancer surgery has increased after adopting the technique of nerve-sparing dissection and total mesorectal excision. Still the rate of sexual and urinary dysfunction ranges between 25 and 67%. The precise locations where nerve damage occurs have not been looked at systematically., Material and Methods: In ten human corpses and two formalin-fixed human pelvises the autonomous pelvic nerves were isolated. Their relation according to surgical mobilization of the rectum were photodocumented., Results: Pelvic autonomous nerves are clearly defined structures with only minor interindividual variability. The inferior mesenteric plexus forms a dense network around the inferior mesenteric artery (AMI) to a distance of 5 cm from the aorta. The distance between the lateral rectum and the pelvic plexus is only 2-3 mm. The anterior rectum is almost directly adherent to the neurovascular bundle, separated only by Denonvillier's fascia. The parasympathetic branches of the sacral segments S2-S5 cannot be isolated using the standard surgical approach., Conclusion: (1) The nomenclature of fascias and the course of the autonomous pelvic nerves is not clearly defined in the literature; (2) a high tie of the AMI leads to damage of the sympathetic nerves; (3) the narrow space between the anterior and lateral rectum makes sharp dissection under direct vision necessary; (4) fascias and nerves can be used as guiding structures during mobilization; (5) a preservation of selected parasympathetic roots in the small pelvis is not feasible using the standard surgical approach.

Peri-arterial hepatic denervation did not change the low basal plasma glucose levels on the 1st post-operative day in partially hepatectomized animals. On the 2nd post-operative day, the denervated animals had significantly higher basal plasma glucose levels than innervated animals. Basal plasma insulin levels were similar in both resected groups, suggesting a relative hyperinsulinemia in the innervated group. Basal plasma glucagon levels were similar in all groups on the 1st post-operative day, but were significantly raised on the 2nd post-operative day in the two resected groups. After i.v. glucose (0.5 g/kg b.w.) on the 1st post-operative day, or glucagon (10 micrograms/kg b.w.) on the 2nd post-operative day, the absolute increments and eliminations of glucose and insulin were similar in all groups. We conclude that the hypoglycemia observed after partial hepatectomy is not only due to the evident loss of glycogen stores, but is also mediated by mechanisms dependent on the peri-arterial hepatic nerves, possibly through an effect on basal plasma insulin levels.