Chemical lumbar sympathectomy in plantar hyperhidrosis

Plantar hyperhidrosis can cause great changes to an individual's quality of life. We described a case successfully treated by the minimally invasive method of percutaneous injection of 7.0% phenolic solution into the lumbar sympathetic chains.

A total laparoscopic technique for endovascular thoracic stent graft deployment

Background: Limitations of endovascular thoracic aneurym treatment include small, tortuous, or severely calcified iliac Back, arteries. We present our experience with a total laparoscopic access to deploy thoracic endografts.Methods. A total laparoscopic left retrocolic approach was used in all cases. A Dacron conduit was laparoscopically sutured to either the iliac artery or to the aorta directly. The endograft was inserted through this conduit. After graft deployment, the Dacron prosthesis was tunneled to the groin and anastomosed with the femoral artery.Results. The laparoscopic procedure could successfully be performed in 11 patients. In six cases, the aorta was used as all access and in five patients, the iliac arteries were preferred. In one of these cases, the right iliac artery, was used for deployment of the endograft. After successful aorto- or ileo-femoral bypass grafting, all patients had an improvement of their ankle brachial index postoperatively. The mean operative time was almost four hours, including laparoscopy, laparoscopic anastomosis, endograft deployment, and femoral artery anastomosis or profundaplasty.Conclusion: Totally laparoscopic assisted graft implantation in aorta or iliac arteries provides a safe and effective access for the endovascular delivery system. However, further evaluation and long follow-up are necessary to ensure the potential advantages of this technique. It is a less invasive option to overcome access-related problems with thoracic endograft deployment, giving the patient the advantage of a totally minimal invasive procedure. (J Vasc Surg 2010;51:504-8.)

Relationship of upper-limb and thoracic muscle strength to 6-min walk distance in COPD patients

Study objectives: This study was developed to investigate the influence of thoracic and upperlimb muscle function on 6-min walk distance (6MWD) in patients with COPD.Design: A prospective, cross-sectional study.Setting: the pulmonary rehabilitation center of a university hospital.Patients: Thirty-eight patients with mild to very severe COPD were evaluated.Measurements and results: Pulmonary function and baseline dyspnea index (BDI) were assessed, handgrip strength, maximal inspiratory pressure (Pimax), and 6MWD were measured, and the one-repetition maximum (1RM) was determined for each of four exercises (bench press, lat pull down, leg extension, and leg press) performed on gymnasium equipment. Quality of life was assessed using the St. George Respiratory Questionnaire (SGRQ). We found statistically significant positive correlations between 6MWD and body weight (r = 0.32; p < 0.05), BDI (r = 0.50; p < 0.01), FEV, (r = 0.33; p < 0.05), PImax (r = 0.53; p < 0.01), and all values of 1RM. A statistically significant negative correlation was observed between 6MWD and dyspnea at the end of the 6-min walk test (r = -0.29; p < 0.05), as well as between 6MWD and the SGRQ activity domain (r = -0.45; p < 0.01) and impact domain (r = -0.34; p < 0.05) and total score (r = -0.40; p < 0.01). Multiple regression analysis selected body weight, BDI, Pimax, and lat pull down IRM as predictive factors for 6MWD (R-2 = 0.589).Conclusions: the results of this study showed the importance of the skeletal musculature of the thorax and upper limbs in submaximal exercise tolerance and could open new perspectives for training programs designed to improve functional activity in COPD patients.

Effects of cervical sympathectomy on vasospasm induced by meningeal haemorrhage in rabbits

This study investigates the role of cervical sympathectomy in the prevention of acute vasospasm induced by meningeal haemorrhage in rabbits. Sixteen adult English Norfolk rabbits were divided into 2 experimental groups: bilateral cervical sympathectomy of the superior sympathetic ganglion (SSSG, n=8), and bilateral SSSG and sympathectomy of the inferior sympathetic ganglion (SISG, n=8). Other 24 animals were used as controls. Basilar artery diameter was evaluated by angiography. SSSG protected the animals against developing cerebral vasospasm; SSSG associated with SISG did not increase this effect.

Hypertrophy and neuron loss: structural changes in sheep SCG induced by unilateral sympathectomy

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Fertility of rat epididymal sperm after chemically and surgically induced sympathectomy

Guanethidine, a chemical that selectively blocks sympathetic noradrenergic neurons, was used to investigate the role of sympathetic innervation in the fertility of rat epididymal sperm, using both natural mating and in utero insemination protocols. This animal model correlates, at least in part, with spinal cord injury (SCI) in men. Adult male rats were treated daily by i.p. injections, for 21 or 42 days, with 0 or 6.25 mg/kg guanethidine. To compare the effects of guanethidine-induced sympathectomy with those following surgically induced sympathectomy, the inferior mesenteric ganglion and the proximal hypogastric nerves were removed in another group of rats. Both chemically and surgically induced sympathectomy increased the weight of the epididymis and seminal vesicles/coagulating glands as well as the number and the transit time of cauda epididymal sperm. Neither serum testosterone levels nor LH was affected by treatment with guanethidine. Using natural mating, no litters were produced by guanethidine-treated rats. Chemically denervated rats failed to produce copulatory plugs or ejaculate into the uterus. However, distal cauda epididymal sperm from chemically or surgically denervated rats displayed normal fertilization ability (80%) using in utero inseminations. In addition, the sperm of denervated rats did not show abnormal sperm chromatin structure using an assay that detects DNA damage. We conclude that sympathectomy delays the transit of sperm through the cauda epididymidis and produces ejaculatory dysfunction but does not compromise sperm quality in the distal cauda epididymidis. Moreover, these data provide compelling evidence that there is no association between the prolonged transit time of sperm within the epididymis, i.e., pre-ejaculatory sperm aging, and the fertility of those sperm, which has important implications for artificial insemination using sperm from men with SCI.

Rat epididymal sperm quantity, quality, and transit time after guanethidine-induced sympathectomy

Guanethidine, a chemical that selectively abolishes peripheral noradrenergic nerves, was used to investigate the role of sympathetic innervation in the maintenance of epididymal sperm quantity and quality. Four groups of 10 adult male rats each were treated daily for 21 days, by i.p. injections, with either 0 (saline vehicle), 6.25, 12.5, or 25 mg/kg guanethidine. Norepinephrine content was reduced to undetectable levels in the cauda epididymidis in all guanethidine groups after 3 wk of treatment and was reduced to 7.4% of the control values after 1 wk of 6.25 mg/kg treatment. While body weight gain was significantly decreased at 12.5 and 25 mg/kg compared to that in controls, there was a significant increase in the weights of the seminal vesicles/coagulating glands in all treated groups. The number of homogenization-resistant spermatids per testis and the daily sperm production per testis remained unchanged. The weight of the epididymis was significantly increased at 6.25 and 12.5 mg/kg. Moreover, the number of cauda epididymal sperm and the transit time were increased significantly at 6.25 mg/kg (10.2 days) compared to values in the control cauda (6.3 days). Neither serum testosterone levels nor LH was affected in a dosage-related manner. There were no effects of guanethidine treatment on cauda epididymal sperm motility or morphology. A quantitative analysis of detergent-extracted cauda epididymal sperm proteins by SDS-PAGE revealed no differences, but there were diminutions in seven proteins in homogenates of caput/ corpus tissue. Histologic analysis of testis and epididymis sections revealed no differences between control and denervated animals. In a subsequent experiment the lowest effective dosage (6.25 mg/kg) was given to rats for 1 wk, and an increased number of cauda epididymal sperm and a delay in sperm transit were observed. Our results indicate that low-dosage guanethidine exposure denervates the epididymis within 1 wk, thereby delaying epididymal transit; however, neither 1- nor 3-wk exposure produces qualitative changes in the sperm.

The Anatomy of the Thoracic Spinal Canal Investigated with Magnetic Resonance Imaging

BACKGROUND: We investigated, with magnetic resonance imaging, the distance of the dura mater to the spinal cord in patients without spinal or medullar disease at the 2nd, 5th, and 10th thoracic segments.METHODS: Fifty patients in the supine position underwent magnetic resonance imaging. Medial sagittal slices of the 2nd, 5th, and 10th thoracic segments were measured for the relative distances using the 1.5-T superconducting system (Gyroscan Intera, Philips Medical Systems, Best, the Netherlands). In 10 patients, the angles relative to the tangent at the insertion point on the skin were measured.RESULTS: The posterior dural-spinal cord distance is significantly greater at the midthoracic region (5th thoracic = 5.8 +/- 0.8 mm) than at the upper (2nd thoracic = 3.9 +/- 0.8 mm) and lower thoracic levels (10th thoracic = 4.1 +/- 1.0 mm) (P < 0.015). There were no differences between interspaces T2 and 110. There was no correlation between age and the measured distance between the dura mater and the spinal cord. The entry angle of the needle at T2 was 9.0 degrees +/- 2.5 degrees; at T5, 45.0 degrees +/- 7.4 degrees; and at T10, 9.50 degrees +/- 4.2 degrees.CONCLUSIONS: This study demonstrated that there is greater depth of the posterior subarachnoid space at the T2, T5, and T10 levels. The greater distance was found at T5. (Anesth Analg 2010;110:1494-5)

MORPHOMETRIC AND BIOCHEMICAL EVALUATION OF RAT PROSTATE AND SEMINAL-VESICLE FOLLOWING CHEMICAL SYMPATHECTOMY WITH GUANETHIDINE

Selective chemical sympathectomy of the internal genital organs of adult male rats was undertaken by chronic treatment with low doses of guanethidine. Biochemical and morphometric methods revealed that removal of sympathetic innervation prevents fructose secretion in the prostate and seminal vesicle, in addition to promoting reduced efficiency of delivery by the latter.

THE HYPOPHYSEAL-TESTICULAR AXIS AND SEX ACCESSORY-GLANDS FOLLOWING CHEMICAL SYMPATHECTOMY WITH GUANETHIDINE OF PRE-PUBERTAL TO MATURE RATS

Selective chemical sympathectomy of the internal sex organs of prepubertal to mature male Wistar rats was performed by chronic treatment with low doses of guanethidine. Plasma testosterone and luteinizing hormone and the intratesticular level of testosterone were determined. The weight and fructose content of seminal vesicle and ventral prostate were also investigated. The results showed that sympathetic innervation is related to the control of the hypophyseal-testicular axis as well as to the growth and potential secretory activity of the male sex accessory glands.

Experimental study of progressive facial hemiatrophy: effects of cervical sympathectomy in animals

Progressive facial hemiatrophy (Romberg's syndrome) is of unknown cause and uncertain pathogenesis. The main pathogenetic hypotheses are: sympathetic system alterations, localized scleroderma, trigeminal changes, possibly of genetic origin. To test the hypothesis of sympathetic system alterations, we designed an experimental model with ablation of the superior cervical sympathetic ganglion in rabbits, cats and dogs. All the animals were operated upon when 30 days old and were examined monthly for 1 year. During this period localized alopecia, corneal ulceration, keratitis, strabismus, enophthalmos, ocular atrophy, hemifacial atrophy and slight bone atrophy on the side of the sympathectomy were observed. Thus, cervical sympathectomy reproduces in animals the principal clinical alterations of Romberg's syndrome. Our data suggest that the sympathetic system is involved in the pathogenesis of this syndrome.

CHEMICAL SYMPATHECTOMY BLOCKS ANDROGEN BIOSYNTHESIS DURING PREPUBERTY

Twenty-one-day old male Wistar rats were injected subcutaneously with guanethidine (GUA) at doses of 5 and 10 mg kg(-1) day(-1) for 20 days. Animals were sacrificed by decapitation during the prepubertal (41 days of age) and early-pubertal (51 days of age) periods of sexual development. The testes were collected, frozen in liquid N-2 and stored at -70 degrees C until determination of testicular progesterone (P): androstenedione (A) and testosterone (T). Higher levels of P (2.18 +/- 0.24 ng/g. control = 1.24 +/- 0.16 ng/g) associated with decreased levels of androgens (A = 0.26 +/- 0.06 ng/g and T = 2.05 +/- 0.19 ng/g; control = 1.86 +/- 0.76 ng/g and 8.48 +/- 1.16 ng/g, respectively) were observed in 10 mg GUA-treated rats of prepubertal age, while only P levels (3.12 +/- 0.51 ng/g control = 1.73 +/- 0.27 ng/g) were increased in rats of early pubertal age. It is important to note that in 41-day old male rats both 5 and 10 mg were effective in decreasing testicular concentration of testosterone. These results suggest that the sympathetic innervation of the testis is involved in the modulation of androgen biosynthesis, acting through a selective step in the steroid biochemical pathway during the pubertal process and that under the conditions employed the blockage in androgen biosynthesis in the prepubertal stage of sexual maturation is dependent on the dose of GUA.