==================================CMR25================================== 25. Vascular surgery (reconstructive) 1. Profundoplasty 2. Lumbar sympathectomy with by-pass graft Operative technique and indications for. 1 UI - 87111510 AU - B:o:oj S ; Dahll:of AG ; Larsson PA ; Dahlstr:om A TI - The contribution of cholinergic enzymes and acetylcholine from the lumbar sympathetic chain to the rat sciatic nerve. AB - This study was performed to investigate how much of the acetylcholine (ACh), choline acetyltransferase (ChAT) and ACh-esterase (AChE) in the rat sciatic nerve originate from the somatic motor input and from the automatic sympathetic input, respectively. The somatic motor axons to the sciatic nerve were eliminated by surgical transsection of the spinal roots, (rhizotomy) and the autonomic component was removed by surgical resection of the lumbar sympathetic chain bilaterally (sympathectomy). Also combined operations were performed. In intact (non-crushed) sciatic nerve rhizotomy caused a reduction in ACh content by 70%, in ChAT-activity by 55%, and in AChE-activity by 41%. Sympathectomy alone had very little influence on ACh and ChAT, but reduced AChE by 20%. After crushing the nerve 13 hours before sacrifice, all three substances accumulated proximal to the crush region as described previously. When compared to the control group, sympathectomy alone caused a reduction in accumulated amounts of AChE only, while ACh and ChAT accumulations were essentially unchanged. Rhizotomy alone caused a substantial reduction in accumulated amounts of all three substances, but most prominently in ACh and ChAT-amounts. After sympathectomy in combination with rhizotomy ACh-accumulations were very low, and enzyme activities were reduced more than in the group with rhizotomy alone. A certain amount of residual ChAT and AChE was present in the nerve, and the location of this is discussed. The fact that combined sympathectomy and rhizotomy lowered ACh accumulations significantly more than would be expected from the results after either operation alone is commented upon. MH - Acetylcholine/*METABOLISM ; Acetylcholinesterase/*METABOLISM ; Animal ; Axoplasmic Flow ; Choline Acetyltransferase/*METABOLISM ; Male ; Rats ; Rats, Inbred Strains ; Sciatic Nerve/*METABOLISM ; Support, Non-U.S. Gov't ; Sympathectomy ; Sympathetic Nervous System/*METABOLISM SO - J Neural Transm 1986;67(3-4):163-74 2 UI - 86322584 AU - Jankovic J ; Pardo R TI - Segmental myoclonus. Clinical and pharmacologic study. AB - We observed 37 patients (mean age at onset, 48.5 years; range, 13 to 84 years) with segmental myoclonus (18 branchial, 19 spinal). Etiologies for branchial myoclonus included brain-stem demyelination, cerebrovascular disease, Meige's syndrome, cerebral arteritis secondary to bacterial meningitis, central nervous system Whipple's disease, acute cervicomedullary trauma, and cerebellar degeneration. Spinal myoclonus was associated with laminectomy, remote effect of cancer, spinal cord injury, post-operative pseudomeningocele, laparotomy, thoracic sympathectomy, poliomyelitis, herpes myelitis, lumbosacral radiculopathy, spinal extradural block, and myelopathy due to demyelination, electrical injury, acquired immunodeficiency syndrome, and cervical spondylosis. The latency between the predisposing condition and the onset of myoclonus ranged from immediate to 33 years (mean, 2.9 years). In six patients, the myoclonus was the presenting symptom of a serious underlying disease. Treatment with clonazepam, tetrabenazine hydrochloride, or other medications provides a satisfactory control in most patients. MH - Adolescence ; Adult ; Aged ; Brain/PHYSIOPATHOLOGY/RADIOGRAPHY ; Case Report ; Clonazepam/THERAPEUTIC USE ; Electroencephalography ; Electromyography ; Female ; Human ; Male ; Middle Age ; *Myoclonus/DRUG THERAPY/ETIOLOGY/PHYSIOPATHOLOGY/RADIOGRAPHY ; Tomography, X-Ray Computed SO - Arch Neurol 1986 Oct;43(10):1025-31 3 UI - 86306187 AU - Zagzag D ; Fields S ; Romanoff H ; Shifrin E ; Cohen R ; Beer G ; Magora F TI - Percutaneous chemical lumbar sympathectomy with alcohol with computed tomography control. AB - Percutaneous chemical lumbar sympathectomy with alcohol (PCLSA) using computed tomography (CT) control was performed in 8 patients suffering from advanced peripheral arterial occlusive disease. PCLSA under CT guidance was found to be a simple and safe procedure. The use of CT control added precision in the guidance of needle placement. Positive results were obtained in all patients, without significant morbidity. PCLSA may be an alternative to surgical sympathectomy. MH - Adult ; Aged ; Alcohol, Ethyl ; Arterial Occlusive Diseases/ *THERAPY ; Female ; Human ; Lumbar Vertebrae ; Male ; Middle Age ; *Sympathectomy, Chemical ; *Tomography, X-Ray Computed SO - Int Angiol 1986 Apr-Jun;5(2):83-6 4 UI - 86270626 AU - Ellis H TI - Lumbar sympathectomy. AB - Lumbar sympathectomy is used in patients with threatened or early gangrene of the toes where reconstructive arterial surgery is not possible--usually because arteriography has demonstrated absence of a "run off: suitable for endarteriectomy or a bypass graft. It may also be a supplement to reconstructive surgery of the aorta or the common iliac arteries. It is indicated in intractable Raynaud's disease affecting the feet and is particularly helpful in severe hyperhidrosis of the feet. In many cases the procedure can be performed nonoperatively by chemical sympathectomy using an injection of aqueous phenol into the lumbar chain. MH - Autonomic Nerve Block/METHODS ; Human ; Lumbosacral Region ; Postoperative Care ; Sympathectomy/*METHODS ; Sympathetic Nervous System/ANATOMY & HISTOLOGY SO - Br J Hosp Med 1986 Feb;35(2):124-5 5 UI - 86244197 AU - Peyronnard JM ; Charron LF ; Lavoie J ; Messier JP TI - Motor, sympathetic and sensory innervation of rat skeletal muscles. AB - This study reports on the location, number and size of motor, sympathetic and sensory neurons innervating the following muscles of rat: quadriceps femoris (QF), tibialis anterior (TA), extensor digitorum longus (EDL), peroneus longus (PL), gastrocnemius medius (GM) and soleus (SOL). Cells were labelled by application of horseradish peroxidase (HRP) to transected muscle nerves. Counts of neurons were compared with counts of myelinated (MF) and unmyelinated (UMF) fibers in normal, deafferented and chemically sympathectomized nerves. The topographical arrangement of spinal motor nuclei resembled that reported previously in other mammals and birds. Sensory somata were aggregated without precise somatotopic organization, preferentially in one of the lumbar dorsal root ganglia at a segmental level corresponding to that of the motor innervation. Because lumbar sympathetic ganglia were often poorly circumscribed, the segmental position of sympathetic ganglion cells could not be localized with certainty. Sensory and sympathetic somata demonstrated a unimodal size-frequency distribution, while QF, TA and PL motoneurons could be subdivided according to size in alpha and gamma cells. For all muscles except unsuccessfully deafferented QF, counts of motor fibers after deafferentation correlated closely with counts of labelled motoneurons. Similarly, estimates of sympathetic axons, averaging 30,7% of the UMF, in most instances exceeded only marginally the ganglion cell population. In contrast, the number of peripheral afferent fibers outnumbered markedly that of sensory cell bodies, with an average of 2.8 axons per ganglion cell. MH - Animal ; Cell Count ; Ganglia, Spinal/*ANATOMY & HISTOLOGY ; Motor Neurons ; Muscles/*INNERVATION ; Nerve Fibers, Myelinated ; Neurons, Afferent ; Rats ; Spinal Cord/*ANATOMY & HISTOLOGY ; Spinal Nerves/*ANATOMY & HISTOLOGY ; Support, Non-U.S. Gov't ; Sympathetic Nervous System/*ANATOMY & HISTOLOGY SO - Brain Res 1986 May 14;373(1-2):288-302 6 UI - 86236043 AU - Rivers SP ; Veith FJ ; Ascer E ; Gupta SK TI - Successful conservative therapy of severe limb-threatening ischemia: the value of nonsympathectomy. AB - Fourteen patients with severely ischemic extremities but relatively minor degrees of pedal gangrene or ulceration were managed without surgery. Contraindications to direct arterial reconstruction included significant intercurrent illness or generally poor surgical risk, the need for reoperative or difficult distal reconstruction, or the favorable characteristics of the actual lesion. Management consisted of bed rest, simple saline soaks, occasional gentle debridement, and antibiotics when indicated. Seven patients had complete resolution of their lesions for 3 to 48 months, and seven had improvement or stabilization for 3 to 18 months. Only three of the 14 patients have eventually required surgery with limb salvage in one. Revascularization remains the method of choice for managing most severely ischemic extremities. However, the conservative approach described represents an alternative to early amputation, attempts at revascularization, or lumbar sympathectomy in some patients with advanced ischemia. Studies of sympathectomy and pharmacologic agents as effective treatment for ischemic ulcers or gangrene should include control groups treated with the conservative measures outlined herein. MH - Aged ; Amputation ; Antibiotics/THERAPEUTIC USE ; Bed Rest ; Follow-Up Studies ; Gangrene/THERAPY ; Hospitalization ; Human ; Ischemia/ETIOLOGY/*THERAPY ; Leg/*BLOOD SUPPLY ; Leg Ulcer/ THERAPY ; Length of Stay ; Middle Age ; *Sympathectomy ; Vascular Surgery SO - Surgery 1986 Jun;99(6):759-62 7 UI - 86168439 AU - Melliere D ; Veit R ; Becquemin JP ; Etienne G TI - Should all spontaneous popliteal aneurysms be operated on? AB - Operative treatment of spontaneous popliteal aneurysms (S.P.As) is occasionally disappointing. In order to determine the criteria for operation we analyzed retrospectively the fate of 77 S.P.As in 52 patients (mean age, 66 +/- 10 years). S.P.As were divided into 3 groups according to initial symptoms: group I, asymptomatic or mild symptoms, group II, rest pain or toe gangrene, group III, severe ischemia or foot gangrene. Patency rate of arterial reconstruction in groups I, II, III were respectively 83%, 43%, 36%. The course of S.P.As of group I that were not initially operated was not significantly different compared to those operated on, as long as they were frequently reviewed and operated on expeditionaly in cases of complications. The nature of the arterial substitute was the second contributing factor. Quality of run-off had no influence in groups I and II, but was determinant in group III. A good general condition was essential for survival. Operative indications of S.P.As is considered according to classification into 3 groups. Group I: bypass is mandatory, except when the general condition of the patient is poor or when a bad run-off is associated with an unavailable vein. Group II: bypass should be attempted whenever a distal arterial segment seems suitable. Otherwise lumbar sympathectomy may sometimes save a limb. Group III: bypass should be attempted only when the run-off is sufficient and when the tissue damage seems reversible. In the other cases, primary amputation is safer. MH - Adult ; Aged ; Amputation ; Aneurysm/COMPLICATIONS/PATHOLOGY/ *SURGERY ; Atherosclerosis/COMPLICATIONS ; Female ; Gangrene ; Human ; Intermittent Claudication/COMPLICATIONS ; Leg/BLOOD SUPPLY/PATHOLOGY/SURGERY ; Male ; Middle Age ; *Popliteal Artery/ SURGERY ; Prognosis ; Retrospective Studies ; Saphenous Vein/ TRANSPLANTATION ; Thrombophlebitis/ETIOLOGY SO - J Cardiovasc Surg (Torino) 1986 May-Jun;27(3):273-7 8 UI - 86140340 AU - Simma W ; Bassiouny H ; Hartl P ; Br:ucke P TI - Evaluation of profundoplasty in reconstructions of combined aorto-iliac and femoro-popliteal occlusive disease. AB - The results in 135 patients undergoing aorto-iliac and aorto-femoral bypass during 1974-1979 were examined. In most cases, occlusive disease of the iliac arteries was combined with total atherosclerotic occlusion of the superficial femoral arteries and sometimes with additional pathology in the profunda femoris artery. In 18.7%, subsequent vascular procedures became necessary in extremities of patients who had undergone aorto-iliac or aorto-femoral anastomotic procedures without additional profundoplasties. In those cases where the primary reconstruction was combined with profundoplasty the results were very satisfying and subsequent procedures were needed only in 8.8%. The aorta-profunda femoris bypass is now preferred for patients with combined aorto-iliac and femoro-popliteal occlusive disease. Results and technical details are discussed. MH - Aged ; Aorta, Abdominal/SURGERY ; Arterial Occlusive Diseases/ RADIOGRAPHY/*SURGERY ; *Blood Vessel Prosthesis ; Female ; Femoral Artery/*SURGERY ; Human ; Iliac Artery/SURGERY ; Male ; Methods ; Middle Age ; Popliteal Artery/SURGERY SO - J Cardiovasc Surg (Torino) 1986 Mar-Apr;27(2):141-5 9 UI - 86128130 AU - Redman DR ; Robinson PN ; Al-Kutoubi MA TI - Computerised tomography guided lumbar sympathectomy. AB - Fifteen patients had lumbar sympathetic block using needle localisation by computerised tomography. The technique has the advantage that the needle route to the sympathetic plexus can be accurately planned, avoiding damage to other organs. In this study, 13 patients out of 15 had significant benefit from the procedure. MH - Adolescence ; Aged ; Female ; Human ; Lumbosacral Region ; Male ; Middle Age ; Sympathectomy, Chemical/*METHODS ; *Tomography, X-Ray Computed SO - Anaesthesia 1986 Jan;41(1):39-41