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Disruption in the nerve-tumor interaction is now considered as a possible anticancer strategy for treating various cancer types, particularly colorectal cancer. However, the underlying mechanisms are not still fully understood. Therefore, the present study aimed to evaluate the effects of sympathetic and parasympathetic denervation on the inhibition of colorectal cancer progression in early and late phases and assess the involvement of nerve growth factor in denervation mediated anticancer effects. One-hundred and fifty male Wistar rats were assigned into 15 groups. Seven groups comprising the control group, 1,2-dimethylhydrazine (DMH) group, sympathetic denervation group (celiac-mesenteric ganglionectomy and guanethidine sulphate administration), parasympathetic denervation group (vagotomy and atropine administration), and combination group were used in the early-stage protocol. For the late-stage protocol, eight groups comprising the control, DMH, surgical and pharmacological sympathetic and parasympathetic denervation groups, combination group, and 5-flourouracil group were considered. After 8 weeks, sympathetic and parasympathetic denervation significantly reduced ACF numbers in rats receiving DMH. On the other hand, in the late stages, parasympathetic but not sympathetic denervation resulted in significant reductions in tumor incidence, tumor volume and weight, cell proliferation (indicated by reduced immunostaining of PCNA and ki-67), and angiogenesis (indicated by reduced immunostaining of CD31 and VEGF expression levels), and downregulated NGF, β2 adrenergic, and M3 receptors. It can be concluded that parasympathetic denervation may be of high importance in colon carcinogenesis and suggested as a possible therapeutic modality in late stages of colorectal cancer., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objectives: Salivary gland regeneration is closely related to the parasympathetic nerve; however, the mechanism behind this relationship is still unclear. The aim of this study was to evaluate the relationship between the parasympathetic nerve and morphological differences during salivary gland regeneration., Materials and Methods: We used a duct ligation/deligation-induced submandibular gland regeneration model of Sprague-Dawley (SD) rats. The regenerated submandibular gland with or without chorda lingual (CL) innervation was detected by haematoxylin-eosin staining, real-time PCR (RT-PCR), immunohistochemistry and Western blotting. We counted the number of Ki67-positive cells to reveal the proliferation process that occurs during gland regeneration. Finally, we examined the expression of the following markers: aquaporin 5, cytokeratin 7, neural cell adhesion molecule (NCAM) and polysialyltransferases., Results: Intact parasympathetic innervation promoted submandibular gland regeneration. The process of gland regeneration was significantly repressed by cutting off the CL nerve. During gland regeneration, Ki67-positive cells were mainly found in the ductal structures. Moreover, the expression of NCAM and polysialyltransferases-1 (PST) expression in the innervation group was significantly increased during early regeneration and decreased in the late stages. In the denervated submandibular glands, the expression of NCAM decreased during regeneration., Conclusions: Our findings revealed that the regeneration of submandibular glands with intact parasympathetic innervation was associated with duct cell proliferation and the increased expression of PST and NCAM., (© 2021 The Authors. Cell Proliferation Published by John Wiley & Sons Ltd.)

In this review, we highlight recent discoveries regarding mechanisms contributing to nerve-cancer cross-talk and the effects of nerve-cancer cross-talk on tumor progression and dissemination. High intratumoral nerve density correlates with poor prognosis and high recurrence across multiple solid tumor types. Recent research has shown that cancer cells express neurotrophic markers such as nerve growth factor, brain-derived neurotrophic factor, and glial cell-derived neurotrophic factor and release axon-guidance molecules such as ephrin B1 to promote axonogenesis. Tumor cells recruit new neural progenitors to the tumor milieu and facilitate their maturation into adrenergic infiltrating nerves. Tumors also rewire established nerves to adrenergic phenotypes via exosome-induced neural reprogramming by p53-deficient tumors. In turn, infiltrating sympathetic nerves facilitate cancer progression. Intratumoral adrenergic nerves release noradrenaline to stimulate angiogenesis via VEGF signaling and enhance the rate of tumor growth. Intratumoral parasympathetic nerves may have a dichotomous role in cancer progression and may induce Wnt-β-catenin signals that expand cancer stem cells. Importantly, infiltrating nerves not only influence the tumor cells themselves but also impact other cells of the tumor stroma. This leads to enhanced sympathetic signaling and glucocorticoid production, which influences neutrophil and macrophage differentiation, lymphocyte phenotype, and potentially lymphocyte function. Although much remains unexplored within this field, fundamental discoveries underscore the importance of nerve-cancer cross-talk to tumor progression and may provide the foundation for developing effective targets for the inhibition of tumor-induced neurogenesis and tumor progression., (©2020 American Association for Cancer Research.)

Objective: The aim of this study is to investigate the effect of highly selective branches neurotomy of vidian nerve with low temperature plasma on the level of vasoactive intestinal peptide in nasal mucosa of patients with allergic rhinitis. Method: Fifty patients with allergic rhinitis were selected as the experimental group. At the same time, 50 normal adults in our hospital were selected as the control group. Highly selective branches neurotomy of vidian nerve with low temperature plasma was performed to observe the changes of vascular intestinal peptide levels in patients with nasal mucosa and the clinical efficacy. Result: Fifty patients with allergic rhinitis were treated with highly selective branches neurotomy of vidian nerve with low temperature plasma. 28 cases have significant effect and the curative effect was 64.3%-92.1% (average was 77.4±4.5)%; 19 were effective and the therapeutic effect was 31.2%-56.4%, with an average of (43.2±2.9)%; only 3 cases were ineffective, and the therapeutic effect was less than 30%. There was significant difference between the two groups after treatment ( P <0.05). The optical density of vasoactive intestinal peptide was (1 723.3±215.4) and (2 732.3±324.5) in the preoperative and postoperative groups, respectively, with significant differences ( P <0.05). The optical density of vasoactive intestinal peptide in the control group was (1 855.4±429.3), which was significantly different from that in the experimental group before operation ( P <0.05). The difference between the control group and the experimental group after operation have no statistically significant ( P >0.05). Conclusion: Highly selective branches neurotomy of vidian nerve with low temperature plasma can significantly reduce the level of vasoactive intestinal peptide in nasal mucosa of patients with allergic rhinitis, alleviate the symptoms of nasal congestion and paroxysmal sneezing, and improve the prognosis of patients.

Coordinated modulation of sympathetic and parasympathetic nervous activity is required for physiological regulation of tissue function. Anatomically, whilst the peripheral sympathetic and parasympathetic pathways are separate, the distribution of premotor neurons in higher brain regions often overlaps. This co-distribution would enable coordinated regulation and might suggest individual premotor neurons could project to both sympathetic and parasympathetic outflows. To investigate this one submandibular gland was sympathectomized. One of two isogenic strains of the pseudorabies virus, expressing different fluorophores, was injected into the cut sympathetic nerve and the other into the submandibular gland. Independent labeling of the peripheral sympathetic and parasympathetic pathways was observed. Dual-labeled neurons were observed in many CNS regions known to be involved in regulating salivary function. We propose these observations highlight a common pattern of organization of the CNS, providing the anatomical framework for the fine control of organ function required for homeostatic regulation and the coordination of organ responses to enable complex behaviors.

Aim: The Performance of an oncological low anterior rectum resection with preservation of the sympathic and parasympathic nerves is illustrated., Indication: The total mesorectal excision (TME) by Robert Heald et al. is the gold standard for rectal cancer operations which has lowered drastically the local recurrence rate. As the survival data improve, the new focus is the postoperative quality of life with preserving of the bladder and sexual function., Method: We demonstrate an anterior rectal cancer operation with preserving of the sympathetic and parasympathetic nerves step by step., Conclusion: The critical parts of preserving the nerves with the N. hypogastricus superior and inferior as well as the neurovascular bundle "erigent pillar" are demonstrated., (Georg Thieme Verlag KG Stuttgart · New York.)

Purpose: The main and accessory lacrimal glands are involved in reflex and basal secretion of tears, respectively, with the glandular tissue anatomy being similar for both glands. We transplanted part of the main lacrimal gland under the palpebral conjunctiva in a rabbit dry eye model and assessed the therapeutic effect of this procedure., Methods: In New Zealand White rabbits, the greater superficial petrosal nerve was cut unilaterally under a microscope. The other eye served as a normal control. For transplantation, approximately 0.07 g of the main lacrimal gland was harvested from the normal side, labeled with octadecylindocarbocyanine, and transplanted under the palpebral conjunctivae of both eyes. At 1 week and 1 month after the transplantation, the eyes were observed, and the Schirmer tear test and histological examination of the palpebral conjunctiva were performed., Results: On the denervated side, tear flow, measured by the Schirmer tear test, recovered at 1 month after the transplantation of the main lacrimal gland compared with that before transplantation. The contralateral control side showed no changes. On the denervated side, the fluorescein score significantly improved at 1 month after transplantation compared with that before transplantation (P < 0.005), whereas the rose bengal score showed no difference. Histological examination revealed that octadecylindocarbocyanine-labeled transplanted main lacrimal gland tissue was present under the palpebral conjunctiva., Conclusions: These results suggest that the partial transplantation of the main lacrimal gland may be effective for treatment of dry eyes.

Aim: To investigate the role of the pelvic nerve pathway in stress-induced acceleration of colorectal transit and defecation in rats., Methods: Surgical transection of rectal nerves (rectal branches of the pelvic nerve), vagotomy (Vag) or adrenalectomy (Adx) were performed bilaterally in rats. Number of fecal pellet output of these rats was measured during 1-h water avoidance stress (WAS). To evaluate the colonic transit, rats were given phenol red through the catheter indwelled in the proximal colon and subjected to WAS. After WAS session, entire colon and rectum were isolated and distribution of phenol red was measured. Distal colonic and rectal transit was evaluated using glass bead. Rats were inserted the glass bead into the distal colon and evacuation rate of the bead was measured. Neural activation was assessed by immunohistochemical staining of c-Fos and PGP9.5 in colonic whole-mount preparations of longitudinal muscle myenteric plexus (LMMP)., Results: In the sham-operated rats (sham op), WAS significantly increased defecation and accelerated colorectal transit with marked elevation of plasma corticosterone level. Compared with sham-operated rats, increase in the excretion of fecal pellets during WAS was significantly reduced by rectal nerve transection (RNT) (sham op: 6.9 ± 0.8 vs RNT: 4.3 ± 0.6, P < 0.05) or Vag (sham op: 6.4 ± 0.8 vs Vag: 3.7 ± 1.1, P < 0.05), although corticosterone level remained elevated. Adx-rats significantly increased the defecation despite the lower corticosterone level. Distribution pattern of phenol red showed RNT inhibited distal colonic and rectal transit accelerated by WAS, while Vag inhibited proximal colonic transit. Suppression of distal colonic and rectal transit by RNT was further confirmed by the bead evacuation rate (sham op: 80.0% vs RNT: 53.8%). WAS significantly increased the number of c-Fos-immunoreactive neural cells in the LMMP of the proximal and distal colon, whereas c-Fos expression was decreased by RNT in the distal colon (sham op: 9.0 ± 2.0 vs RNT: 4.4 ± 1.0, P < 0.05) and decreased by Vag in the proximal colon., Conclusion: Pelvic nerve conveys WAS stimuli from the brain to the distal colon, and directly activate the myenteric neurons, followed by the increase of its motility.

The hepatic parasympathetic system is one of the major contributors for preserving insulin sensitivity in the postprandial state. Postprandial hepatic vagal control of whole-body glucose clearance and its effect on specific organs remains unknown. Our hypothesis is that, in the postprandial state, the hepatic parasympathetic nerves (HPN) are responsible for a considerable part of extra-hepatic tissue glucose clearance. Two groups of 9-week-old Sprague-Dawley rats were studied, comparing sham-operated versus hepatic parasympathetic denervated animals. Insulin sensitivity was evaluated in the postprandial state by the rapid insulin sensitivity test (RIST). [(3) H]2-deoxy-d-glucose was administered during the RIST. Plasma glucose rate of the disappearance and clearance by skeletal muscle, adipose tissue, liver, pancreas, heart and kidney of this radioisotope was measured. The postprandial denervated group showed a decrease insulin sensitivity of 41.4 ± 5.2%. This group of animals showed a decrease in the rate of plasma [(3) H]2-deoxy-d-glucose disappearance and skeletal muscle, heart and kidney glucose clearance by 45%, 35% and 67%, respectively. These studies show that the major contributor of postprandial whole-body glucose clearance was skeletal muscle; in the range 69-38%, depending on HPN integrity. The results obtained in the present study indicate that HPN are crucial for postprandial action of insulin through a mechanism that is essential for maintenance of skeletal muscle, heart and kidney glucose clearance. These results suggest that hepatic parasympathetic dysfunction could lie at the genesis of type 2 diabetes complications, namely insulin resistance, nephropathy and cardiomyopathy., (© 2011 The Authors. Journal of Neuroendocrinology © 2011 Blackwell Publishing Ltd.)

Objective: In humans, the existence of an anterior periaortic fat pad (AFP) containing parasympathetic ganglia has been described in the aortopulmonary window. Changes in the autonomic nervous system (ANS) tone can lead to postoperative atrial fibrillation (POAF). The AFP is usually removed during coronary bypass grafting (CABG) to fully expose the aortic root. The purpose of this study was to evaluate the influence of AFP removal during CABG on the ANS tone, incidence of POAF, hospital stay, and in-hospital morbidity and mortality., Methods: A total of 215 patients were randomized in this prospective, double-blind trial to either removal (n=107) or maintenance (n=108) of the AFP during their first CABG. All patients underwent continuous telemetry monitoring after surgery. They underwent at least 1-h Holter monitoring on the second postoperative day. Heart rate variability measurements of both time-domain and frequency-domain analysis were included. POAF was defined as AF for more than 5min or causing hemodynamic instability., Results: The mean age was nearly 58 years, and 76% were male. There was no difference in the incidence of POAF between the retained and removed AFP groups (19.3% vs 17%, respectively; P=0.664, odds ratio=1.16). Mean heart rate and heart rate variability parameters, in-hospital stay, and postoperative morbidity and mortality were similar in both groups., Conclusions: Removal of the AFP during CABG has no significant effect on the incidence of POAF, ANS tone, and postoperative morbidity or mortality., (Copyright © 2011 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.)

Aims: This is a continuation of studies examining the effectiveness of root repairs and nerve transfers for bladder reinnervation. Our previous retrograde fluorogold tracing studies from the bladder to the spinal cord found regrowth of axons from the spinal cord through the nerve repair site to the bladder which was confirmed electrophysiologically [Ruggieri et al. J Neurotrauma 25:214–24, 2006]. The current study determines whether the pattern of axonal regrowth from the repaired nerves or roots to the bladder is different between the surgical reanastomosis methods., Methods: The canine bladder was denervated by transection of all nerve roots from the sacral spinal cord mediating bladder contraction. Reinnervation surgeries included end-on-end repair of transected sacral ventral roots, transfer of coccygeal to sacral ventral roots(CGNT),or transfer of genitofemoral to pelvic nerves(GFNT)., Results: Postmortem dialkylcarbocyaninedye tracing with Neurotrace DiI from the distal pelvic nerve to the bladder wall, combined with PGP9.5 neuronal immunohistochemistry, demonstrated innervation by DiI-labeled axons of only parasympathetic postganglionic intramural ganglia in normal controls and sham operated controls, but reinnervation of both intramural ganglia and detrusor muscle directly after repair of sacral ventral roots. GF NT and CG NT also resulted in reinnervation of both intramural ganglia and detrusor muscle, although to a lesser extent than repaired roots., Conclusions: Bladder reinnervation with either the same nerve (orthotopic reinnervation) or with either a primarily somatic nerve (coccygeal) or a primarily sensory nerve (genitofemoral) results in reinnervation of both intramural ganglia as well as direct innervation of detrusor muscle.

Vidian neurectomy yields dramatic relief of nasal hypersecretion in patients with allergic rhinitis. Clinical studies conducted on vidian neurectomized nasal mucosa have shown that nasal hypersecretion observed after challenging the nasal mucosa with antigen is caused by reflexively induced activation of the parasympathetic center secondary to stimulation of the sensory nerve terminals in the nasal mucosa by histamine. On the contrary, nasal mucosal swelling is caused mostly by the direct effects of chemical mediators on the nasal vasculature, although vascular reflex mediated by the noncholinergic parasympathetic nerve may be partially involved in the onset of nasal mucosal swelling after antigen challenge. Considering the long-term side effects of inhibition of lacrimation and possible partial recurrence of hyperreactive nasal symptoms observed after vidian neurectomy, less invasive endoscopic posterior nasal neurectomy is considered the treatment of choice for patients with allergic rhinitis who require surgical intervention.

Cerebral insulin can regulate glucose homeostasis via activation of the parasympathetic nervous system, which results in the reduction of hepatic glucose output. However, the precise mechanism(s) through which cerebral insulin directly exerts an effect on insulin secretion remains unclear. In the present study, we found that cerebral administration of insulin caused an increase of plasma insulin concentration and a concomitant decrease in plasma glucose levels within one hour. These effects were blocked by vagotomy or intraperitoneal injection of 1,1-dimethyl-4-diphenylacetoxypiperidinium iodide, a specific M (3) antagonist. The mediating influence of parasympathetic activation can thus be considered. The adenosine triphosphate-sensitive potassium (K-ATP) channel is a key mediator of the cerebral action of insulin. The plasma glucose-lowering action of insulin was abolished by cerebral administration of glibenclamide or repaglinide at concentrations sufficient to block K-ATP channels. In conclusion, our findings suggest that cerebral insulin may induce insulin release by stimulating the opening of K-ATP channels, which in turn activate parasympathetic tone in pancreatic tissue., (Georg Thieme Verlag KG Stuttgart * New York.)

With the concept of the improvement of quality of life in the field of surgical oncology, recent studies have questioned the place of radical hysterectomy (RH) in the treatment of cervical carcinoma due to a high rate of long-term postoperative complications involving the pelvic autonomic nerve system. It has been demonstrated that RH frequently causes bladder dysfunction, anorectal mobility disorders, and sexual dissatisfaction in cervical cancer survivors due to surgical trauma involving the sympathetic and parasympathetic branches of the autonomous innervation of the pelvic organs. Nerve-sparing RH was first pioneered by Takashi Kobayashi in Japan and then other Japanese gynecologic surgeons introduced and improved this concept to Western countries. However, nerve-sparing RH has only become popular among gynecologic surgeons during the last two decades. Recently, European gynecologic surgeons modified this concept. Herein, a review of the evolution of nerve-sparing RH, a quick overview of long-term pelvic organ dysfunctions associated with RH, and the technical details of different authors and their oncological outcomes are presented. Today, the lack of randomized studies comparing the effectiveness and complications of RH with nerve-sparing RH is an important barrier to the widespread use of this concept. Nonetheless, while nerve-sparing RH still awaits prospective randomized trials in order to prove that its effectiveness is equal to or greater than that of conventional treatment modalities, and that is has fewer long-term complications, this surgical approach remains attractive for the patients and gynecologic oncologists based on the published results.

Objective: To introduce a novel surgical technique for the dissection of the greater superficial petrosal nerve (GSPN) in the middle fossa approach., Methods: Interdural temporal elevation was performed with a front-to-back technique to preserve the GSPN in 12 sides of 6 injected cadaveric heads dissected through a middle fossa approach., Results: The GSPN emerged from the facial hiatus in a shallow bony groove proximally, ran into a deeper sphenopetrosal groove, and eventually reached the mandibular nerve. With front-to-back dissection, this nerve was easily identified at the posterior border of the mandibular nerve. Dissection from front to back minimized the retraction force applied to the proximal part of the GSPN, which was preserved in all specimens., Conclusion: The temporal dura can be elevated safely with a front-to-back technique to preserve the GSPN and to help maintain the physiological integrity of the facial nerve.

Objective: The vidian canal, the conduit through the sphenoid bone for the vidian nerve and artery, has become an important landmark in surgical approaches to the cranial base. The objective of this study was to examine the anatomic features of the vidian canal, nerve, and artery, as well as the clinical implications of our findings., Methods: Ten adult cadaveric specimens and 10 dried skulls provided 40 vidian canals for examination with x 3 to x 20 magnification and the endoscope., Results: The paired vidian canals are located in the skull base along the line of fusion of the pterygoid process and body of the sphenoid bone. The canal opens anteriorly into the medial part of the pterygopalatine fossa and posteriorly at the upper part of the anterolateral edge of the foramen lacerum. The vidian nerve, when followed posteriorly, reaches the lateral surface of the anterior genu of the petrous carotid and the anteromedial part of the cavernous sinus where the nerve is continuous with the greater petrosal nerve. The bone surrounding the upper part of 12 of 20 vidian canals protruded into the floor of the sphenoid sinus and one canal had a bony dehiscence that exposed its contents under the sinus mucosa. Nine petrous carotid arteries (45%) gave rise to a vidian artery, all of which anastomosed with the vidian branch of the maxillary artery in the vidian canal or pterygopalatine fossa. The vidian canal can be exposed by opening the floor of the sphenoid sinus, the posterior wall of the maxillary, the posterior part of the lateral wall of the nasal cavity, and the medial part of the floor of the middle fossa., Conclusion: The vidian canal and nerve are important landmarks in accessing the anterior genu of the petrous carotid, anteromedial part of the cavernous sinus, and petrous apex.

There is evidence that parasympathetic denervation may prevent atrial fibrillation (AF) recurrences. This study aimed at applying an anatomic approach for ablation of atrial ganglionic plexi (GPs) in patients with paroxysmal AF. Nineteen patients with symptomatic, paroxysmal AF underwent anatomically guided radiofrequency ablation at the location of the 4 main left atrial GPs and were prospectively assessed for recurrence of AF or other atrial arrhythmia. This group was compared with 19 age- and gender-matched patients who previously underwent conventional circumferential pulmonary vein ablation. All ablation procedures were uneventful. Circumferential and GP ablations were accomplished with a radiofrequency delivery time of 28 +/- 5 versus 18 +/- 3 min (p <0.001) and a fluoroscopy time of 31 +/- 5 versus 18 +/- 5 min (p <0.001), respectively. Parasympathetic reflexes during radiofrequency ablation were elicited in 4 patients (21%). Arrhythmia recurred in 7 patients (37%) with circumferential ablation and 14 patients (74%) with GP ablation, during 1-year follow-up (p for log-rank test = 0.017). In 2 patients with GP ablation, left atrial flutters were documented in addition to AF during follow-up. Patients who underwent GP ablation had an almost 2.5 times higher risk of AF recurrence compared with those who underwent circumferential ablation (hazard ratio 2.6, 95% confidence interval 1.0 to 6.6, p = 0.038). In conclusion, anatomically guided GP ablation is feasible and safe in the electrophysiology laboratory, but this approach yields inferior clinical results compared with circumferential ablation.

Objective: To study the pathological change of benign hyperplastic prostate after removal of the innervation of cholinergic parasympathetic pelvic nerve., Methods: Sixty-five male spontaneous hypertension rats (SHRs) were randomly assigned into 3 groups: operation group (n = 30) undergoing truncation of bilateral originating branches of parasympathetic pelvic nerve of major pelvic ganglion (MPG) followed by cystostomy, sham operation group (operation control group, n = 30) undergoing cystostomy, and normal control group (n = 5) not undergoing operation. 3, 7, 11, 15 and > or = 21 days after operation 6 rats from the 2 operation groups and 1 from the control group were sacrificed to observe the gross morphology and histological and cellular changes of the prostate glands., Results: The prostate of the operation group on post-operational day 7 showed mild granular solidification and such change progressed gradually over time, the ratio of prostate wet weight/rat body weight was (0.4764 +/- 0.0125) mg/g on day 3, then gradually decreased, and became (0.2749 +/- 0.0197) mg/g > or = 21 days post-operationally; while the ratio of prostate tissue dry weight/wet weight on day 3 was (0.1966 +/- 0.0062), then gradually increased, and became (0.2596 +/- 0.0035) > or = 21 days post-operationally. HE staining showed that the glandular structure gradually became dilated and rounded, with accumulation of prostatic fluid. The glandular epithelial cells showed gradual degeneration, necrosis, and detachment. The glandular epithelium became progressively thinner, the smooth muscles elongated and thinned progressively, and the stromal components showed mild to moderate overgrowth. Electron microscopy showed that the glandular cells gradually underwent vacuolar degeneration and the structures of the basement membrane became fuzzy. The smooth muscle cells degenerated mildly, and the fibroblasts and collagenous fibers in the stroma overgrew slowly. All these histological changes were not found in the sham operation control and normal control groups., Conclusion: Remarkable atrophy occurs in benign hyperplastic prostatic gland after radical removal of the innervation of cholinergic parasympathetic pelvic nerve. Such operation may represent a novel therapy for BPH.

Aim: Neurogenic low urinary tract dysfunctions unresponsive to medical and conservative therapy are difficult to manage. Nowadays they can be treated with Sacral Nerve Stimulation (SNS), even if clinical experiences reported in literature are still limited., Methods: We performed SNS in 6 patients with neurogenic bladder: 3 patients had incontinence-urgency (1 myelitis, 1 multiple sclerosis, 1 autonomic polineuropathy) and 3 patients had urinary retention (1 incomplete spinal cord lesion, 1 operation for discal hernia T5-T6, 1 hysterectomy)., Results: Among cases with incontinence-urgency we achieved complete control of the bladder in 2 patients while in 1 patient the number of urinary losses was reduced of the 80%. In 2 patients with urinary retention we obtained complete recovery of the bladder function, while in 1 patient the number of cateterisms/die reduced of 50%, the urinary volume for micturion increased and residual urinary volume decreased. Results were unchanged during the follow-up (maximum 26 months), except for 1 patient in which a partial loss of effectiveness occurred., Conclusions: Chronic electric stimulation of S3 sacral roots via an implanted neuroprotesis is therefore an effectiveness, save and promising therapeutic option in treatment of neurogenic bladder dysfunctions.

Objective: To research the therapy effect of perennial allergic rhinitis (PAR) with anterior-ethmoid neurotomy, and to observe the pathological changes of SP nerve fibres., Method: In 46 cases (neurotomy group, NG) of PAR anterior-ethmoid neurotomy were performed, the surgery effect was evaluated according to the Chinese Hai Kou allergic rhinitis diagnosis and curative access standard (1997) and compared with 17 cases simulating operation without neurotomy (non-neurotomy group, NNG) by clinical symptoms controlled counting-scores. The substance P in nasal mucous membrane of NG was observed with immunohistochemical test, meanwhile the square of positive-stained nerve fibres on the sections were measured with a quantitative analysis method after and before operation, which also were compared with that of 14 cases patients without rhinopathy (normal controlled group, NCG)., Result: The average score reduced from 12.93 pre-operation to 6.14 post-operation (P < 0.01) in NG, but in NNG there is no significant different before and after therapy. The squares of SP immune response (SP-IR) positive-stained fibers were significant different between pre-operation and post-operation in NG. The quantities of SP-IR positive-stained fibers in nasal mucous membrane were more in PAR patients (before operation) that that in the NCG., Conclusion: The anterior-ethmoid neurotomy with plasm technique is an effective and simple therapical method for treating PAR. The SP of anterior--ethmoid nerve plays an important role in the pathological mechanism of PAR.

Background: The 60 year old women with no prior history of arrhythmia or other cardiac symptoms was operated on for a cervical disc herniation at the level C7/D1. The C8 nerve root was visualized via a posterior approach., Findings: Removal of the sequestrum and irritation of the anterior root with surgical instruments triggered cardiac arrest., Interpretation: We offer the opinion that irritation of the anterior root led to diminished activity of the supraspinal sympathetic control system and consecutive hyper-activation of the parasympathetic system.

Effects of unilateral parasympathetic denervation of ovine parotid glands were examined in anaesthetized sheep 21-28 days after nerve section. Parasympathetic denervation reduced the mass of the ipsilateral gland while increasing that of the contralateral gland to the extent that total gland mass was greater than in sheep with normally innervated glands. The spontaneous secretion (8.8 +/- 1.1 microl min(-1) g gland(-1)) was significantly less from denervated than from innervated glands of normal control animals (26.0 +/- 2.7 microl min(-1) g gland(-1); P< 0.01) and contained more protein. Rates of flow, and the outputs of sodium and potassium, in response to sympathetic stimulation, were similar from normally innervated and chronically denervated glands, when allowance was made for the discrepancy in weights, whereas the output of protein was significantly enhanced following parasympathetic denervation (innervated--31.4 +/- 7.3 microg g gland(-1), denervated--83.4 +/- 26.6 microg g gland(-1); P< 0.05). Intra-arterial infusions of acetylcholine (130 pmol min(-1) kg(-1)) elicited a flow of parotid saliva, the protein content of which was significantly enhanced by prior parasympathetic denervation. Intra-arterial infusions of vasoactive intestinal peptide (VIP; 2.5 pmol min(-1) kg(-1)) produced a small but statistically significant (P< 0.05) increase in the flow of parotid saliva from the contralateral, innervated but not from denervated glands. It also caused a small increase in protein output, which was significantly enhanced by prior denervation. VIP had no synergistic effect on the parotid responses to acetylcholine. The results show that the parasympathetic innervation to the parotid gland of the sheep exerts important trophic effects on the gland. Interaction of adrenergic and cholinergic receptors makes an important contribution to stimulation of the secretion of protein and prior denervation potentiates the protein responses to both acetylcholine and VIP.

The effect of cutaneous mechanical stimulation on choroidal blood flow (ChBF) of the eyeball measured using a laser Doppler flowmeter was examined in anesthetized rats. Noxious pinching stimulation of a forepaw for 20 s produced increases in ChBF and mean arterial blood pressure (MAP), whereas brushing of a forelimb produced no changes in either parameter. After spinal transection at the fourth thoracic (T4) level, forepaw pinching stimulation did not produce any MAP changes in 9 of 11 spinalized rats. In these nine spinalized animals, pinching stimulation of a forepaw produced no significant responses in ChBF. After the cutting of cervical sympathetic trunks in five spinal rats, forepaw pinching showed no effect on MAP, but produced an increase in ChBF, which was abolished by an intravenous (i.v.) injection of 1-(2-trifluoromethylphenyl) imidazole (TRIM), a selective inhibitor of neuronal nitric oxide synthase (nNOS). In another four spinalized rats, whose cervical sympathetic trunks were intact and the superior salivary nucleus (SSN) was destroyed, forepaw pinching showed no effect on MAP, but produced a decrease in ChBF, which was abolished by an i.v. injection of phentolamine, an alpha-adrenoceptor antagonist. The present experiment shows that somatic afferent stimulation can produce reflex responses of the ChBF of the eyeball, either a vasodilative response using parasympathetic efferent fibers or a vasoconstrictive response using sympathetic efferent fibers, independent of systemic blood pressure. It was also shown that the somatically induced vasodilative response was due to a release of nitric oxide (NO) from parasympathetic nerves and the vasoconstrictive response was due to a release of noradrenaline from sympathetic nerves.

There is no more severe pain than that sustained by a cluster headache sufferer. Surgical treatment of cluster headache should only be considered after a patient has exhausted all medical options or when a patient's medical history precludes the use of typical cluster abortive and preventive medications. Once a cluster patient is deemed a medical failure only those who have strictly side-fixed headaches should be considered for surgery. Other criteria for cluster surgery include pain localizing to the ophthalmic division of the trigeminal nerve, a psychologically stable individual, and absence of addictive personality traits. To understand the rationale behind the surgical treatment strategies for cluster, one must have a general understanding of the anatomy of cluster pathogenesis. The most frequently used surgical techniques for cluster are directed toward the sensory trigeminal nerve and the cranial parasympathetic system.

Purpose: To present a case of bilateral neurotrophic keratopathy with miosis after bilateral Vidian neurectomy for vasomotor rhinitis., Methods: Observational case report., Results: A 68 year-old man presented with irritation and blurred vision in both eyes 2 weeks after bilateral Vidian neurectomy. Slit-lamp examination revealed a large epithelial defect, typical of neurotrophic keratopathy, in the inferior two-thirds of cornea in both eyes. Corneal sensitivity test with a Cochet-Bonnet anesthesiometer and electrical study of the blink reflex indicated bilateral trigeminal dysfunction. Both pupils were miotic, and tests with hydroxyamphetamine 1% and epinephrine 0.1% showed postganglionic sympathetic nerve damage. The corneal epithelial defects healed after 2 months of treatment with systemic prednisolone, vitamin B(12) and tarsorrhaphy., Conclusion: Neurotrophic keratopathy associated with dry eye syndrome may be a serious complication of Vidian neurectomy.

Objective: To decrease postoperative morbidity associated with radical hysterectomy Rutledge type III, we identified the parasympathetic innervation of the bladder in the cardinal ligament., Methods: During laparoscopic dissection of the cardinal ligament, we used 7x magnification on 38 consecutive patients with cervical cancer stages IB1 to IIIA with high risk for parametrial involvement when we performed laparoscopy-assisted radical vaginal hysterectomy type III between August 1997 and January 1999., Results: The middle rectal artery was identified as a landmark separating the vascular from the neural part of the cardinal ligament. The neural part was shown to contain the splanchnic pelvic nerves which anastomose with the pelvic plexus. Following preservation of these neural structures all patients were able to void their bladder spontaneously. Following nerve-sparing technique, patients regained bladder function significantly quicker compared with a control group (n = 28) in which the neural part of the cardinal ligament had not been preserved: suprapubic drainage 11.2 days versus 21.4 days (P = 0.0007)., Conclusion: Using the middle rectal artery as a landmark the neural part of the cardinal ligament can be preserved, resulting in preservation of the motor function of the bladder., (Copyright 2000 Academic Press.)

Traditional rectal cancer surgery has been burdened with a high rate of sexual and urinary dysfunctions due to intraoperative injury or the cutting of the sympathetic and/or parasympathetic nerves. The experience acquired in the last ten years with total mesorectal excisions has permitted the use of the "nerve-sparing" technique. The present study regards 239 patients from two surgical centres, most of whom underwent sphincter-saving radical surgery between 1994 and 1998 with the above mentioned technique for resectable colon cancer. Details regarding the technique were recorded in the last 58 patients, in order to examine the severity of the surgical damage. The subgroup with the longest follow-up, which included 36 patients, was diagnostically evaluated by a surgeon, psychologist, urologist and neurologist to analyze the risk of sexual and urinary dysfunctions. A complete nerve-sparing was performed in 86.3% of the cases. The parasympathetic nerve trunks were those most often damaged because of perineural tumor spreading. Partial to complete sexual impotence was observed in 44% of the patients and surprisingly, preoperative dysfunctions were detected by means of the multidisciplinary approach in one third of these patients. Therefore, only 30.5% of the patients presented with strictly postoperative sexual impotency, above all, those who had undergone high-dose preoperative chemoradiation for T3 or T4 middle to low rectal cancer. A prospective study was initiated to evaluate the genitourinary dysfunctions after rectal cancer surgery in all of the clinical phases by means of a multidisciplinary approach aimed at functional recovery and improved quality of life.

Unlabelled: Radiofrequency (RF) catheter ablation of supraventricular tachycardias (SVT) has been shown to result in local parasympathetic denervation. The purpose of this study was to estimate the correlation between RF cumulative energy and parasympathetic denervation at three different ablation sites., Methods: 45 patients who underwent RF ablation of 36 AV reentrant tachycardias and 9 AV nodal reentrant tachycardias were studied. Twenty patients had left free-wall accessory pathways (group L), 8 patients right free-wall accessory pathways (group R), and 17 patients septal accessory pathways (n = 8) or slow pathways (n = 9) (group S). Time and frequency domain analysis of heart rate variability on 24-hour ambulatory ECG recordings was performed before and after RF ablation. pNN50 and the high frequency (0.15 to 0.40 Hz, HF) component were measured to examine the effects on parasympathetic nerve activity. The values of delta pNN50 and delta HF were expressed as the percent change of pNN50 and HF that occurred after versus before RF ablation., Results: Both pNN50 and HF significantly decreased after RF ablation in all three groups. In group S, there was a significant correlation between RF cumulative energy and delta pNN50 (r = 0.66, P < 0.01) or delta HF (r = 0.58, P < 0.05). In contrast, there was no correlation between RF cumulative energy and delta pNN50 or delta HF in either group L or group R., Conclusion: These data suggest that RF ablation produces parasympathetic denervation at all three sites along the mitral or tricuspid annulus and that parasympathetic fibers may be located predominantly in the septal area.

Orthotopic heart transplantation has become an established treatment for selected patients with refractory heart failure. Long-term survival rates are superior to those resulting from other forms of therapy for that patient population. In addition, an improved quality of life has been reported by many patients. However, despite these encouraging results, the transplanted heart does not provide the recipient with normal cardiac function. Cardiac physiology after heart transplantation is unique. Resting hemodynamics differ significantly, acutely and chronically, from those seen in healthy subjects. In addition, neural mechanisms undergo changes as a result of surgical denervation. Afferent control mechanisms and efferent responses both are altered, leading to important clinical abnormalities. Examples include altered cardiovascular responses to exercise, altered cardiac electrophysiology, and altered responses to cardiac pharmacologic agents. An improved understanding of the changes in cardiac physiology, which occur after heart transplant, may allow the care of these patients to be optimized.

To assess the potentially adverse effects of RF catheter ablation (RFCA) of the slow AV nodal pathway on the parasympathetic innervation to the AV node in patients with AV nodal reentrant tachycardia (AVNRT), AV nodal conduction was evaluated following vagal stimulation by means of a phenylephrine bolus injection (200 micrograms) before and after RFCA in ten patients (mean age, 37 +/- 14 years). Nine patients with AV reentrant tachycardia (AVRT) due to a left free wall accessory pathway served as a control group (mean age of 37 +/- 12 years). Whereas no prolongation of the AH interval was observed in the AVNRT group following the phenylephrine bolus during sinus rhythm, despite a significant slowing in sinus rate, phenylephrine administration in AVRT patients was associated with both slowing of the sinus rate and prolongation of the AH interval. Following successful RFCA, the same responses were observed. To delineate the indirect effect of heart rate on AV conduction in response to the phenylephrine bolus, the AH interval was also measured during fixed atrial pacing. A marked prolongation of the AH interval occurred in both groups following phenylephrine administration. This prolongation was biphasic in 50% of AVNRT patients before ablation, suggesting a predominant effect of vagal stimulation on the fast AV nodal pathway. RFCA was associated with disappearance of discontinuous AV conduction in all but one patient with AVNRT. Vagal stimulation caused the same amount of AH interval prolongation as before RFCA in both study groups. In conclusion, patients with AVNRT have a preserved modulation of AV nodal conduction in response to vagal stimulation during sinus rhythm. In addition, vagal stimulation seems to exert a predominant effect on the fast AV nodal pathway. RFCA of the slow AV nodal pathway in patients with AVNRT does not cause detectable damage to the vagal innervation to the AV node.

The effect of removal of cerebrovascular sympathetic, parasympathetic or sensory nerve on brain cortical blood flow and spontaneous vasomotion during changes in systemic blood pressure was studied by laser-Doppler flowmetry in anaesthetized rats. Selective section of sympathetic fibres along the internal carotid artery markedly affected the ability to autoregulate, as measured in microvessels of the middle cerebral arterial territory. Removal of the parasympathetic nerves tended to reduce the ability to autoregulate, whereas no significant influence was found after sensory denervation. Following the denervations, spontaneous vasomotion was not significantly affected in frequency or amplitude.

As with all branches of surgery, selection of the appropriate operative procedure for a particular patient involves careful weighing of all the alternatives and full discussion with the patient and carers. Each of the procedures described has its devotees and detractors. For an individual patient, however, the risks of each, the likely postoperative course and the results of the surgery--both in terms of the expected chance of improvement in drooling and the presence or otherwise of residual scarring or taste--must be balanced to determine the optimum plan for treatment. The long-term results of submandibular duct transposition for drooling in the author's own institution have recently been reported. An initial improvement in the drooling of all patients was maintained for at least two years in 17 of 20 patients. Only two patients experienced complications requiring further surgery (ranulas in each case). It is suggested that these very satisfactory results, achieved without external scarring and without compromising the sense of taste, support the contention that submandibular duct transposition is the surgical treatment of choice for children and young people with cerebral palsy who drool excessively.

This paper describes a method for assessing the efficacy of Wilde's incision based on mathematical analysis of cardiac rhythms. In patients with chronic polypous rhinosinusitis, the parasympathetic nervous system tonicity is found to be predominant. After Wilde's incision through a transmaxillary subperiosteal approach cardiac rhythms change, suggesting the predominance of sympathetic innervation.

Vidian neurectomies by transnasal and transseptal approaches were performed on 21 patients with perennial rhinitis and with a follow-up of 5 years. The results showed that sneezing and watery rhinorrhea relapsed in 85.7% of the operated series and 66.7 per cent in one year after operation. The causes of recurrence were discussed and analysed. We consider that symptoms of sneezing and watery rhinorrhea are induced by a series of factors so that the efficacy of single vidian neurectomy needs further evaluation.

The effects of androgen on the activities of esteropeptidase and delta 4-3-ketosteroid 5 alpha-reductase were investigated. Ratios of the denervated side to the non-operated side for gland weight and esteropeptidase activity were higher in androgenized females than in untreated females. The specific activities of 5 alpha-reductase were increased by denervation but the total activities were decreased. The results suggest that parasympathectomy leads to higher androgen responsiveness in the rat submandibular gland, which relates to the observed reduction in weight loss of the gland and the increases in its esteropeptidase activities.

An anomalous change in response to exogenously applied acetylcholine (ACh) was found in the rat iris dilator muscle after surgical parasympathetic denervation. The relaxation induced by nerve stimulation in the normal dilator muscles disappeared after the denervation. ACh elicited relaxation and contraction at low (less than 3 X 10(-6) M) and higher doses, respectively, in the normal muscles. The relaxing response to ACh was almost abolished after the denervation, while the maximum contractile response to ACh was not affected significantly.

Ninety-three cases of infantile chronic recurrent parotitis are recorded. Fifty-three cases were treated with parasympathectomy which was carried out at 2 levels. Good results were achieved in 79.1% of patients. The paper describes the use of the Doppler examination to study the effects of operation on the physiology of the parotid.

This study involved five patients suffering from bilateral chronic parotiditis and then with a persistent unilateral fistula of the parotid gland. Two types of parotid biopsy were examined: the first taken during surgery and the second six months later. All of the specimens underwent histopathological and histochemical investigations. Definitive degeneration and atrophic type changes were seen in all the parotid fragments removed six months after selective neurectomy of the tympanic plexus. Six months after surgery, all of the patients were cured.

The fine structure of the allergic nasal mucosufollowing vidian neurectomy was studied in 15 patients. The structure of the mucous glands, venules, arterioles and tunical cellular elements returned to normal 1 month after the operation, while that of the epithelium and of the capillaries only 3 months post-operatively. The effect of interrupting the hyperactive cholinergic nerve impulses on the various constituents of the nasal mucosa is described.

Mitotic activity of rat parotid was increased from levels near zero to 10-40 mitotic figures per 1,000 acinar cells (mean, 15/1,000) 2 days after glandular activity was increased from less than normal to normal by replacing liquid diet with a diet of solid chow. This frequency greatly exceeded the maximum (1-3/1,000 acinar cells) observed at any time during the diurnal mitotic fluctuations. This mitotic burst was virtually prevented if the auriculotemporal nerve was removed 2 days prior to introduction of solid chow, but was only somewhat reduced when the superior cervical ganglion was removed prior to the dietary substitution. The parasympathetic innervation also was chiefly responsible for the increased cell size that followed reintroduction of solid food.

The author presents the critical review of Vidian neurectomy since 1961. Golding-Wood (1961, 1962) recommended this type of operation in vasomotor rhinitis. Many authors modified this operation. The author concludes that Vidian neurectomy is indicated in the cases of vasomotor rhinitis with profuse secretion refractory to conservative treatment.