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Late Results Following Operative Repair for Celiac Artery Compression Syndrome
Published in Juan Carlos Jimenez, Samuel Eric Wilson, 50 Landmark Papers Every Vascular and Endovascular Surgeon Should Know, 2020
Juan Carlos Jimenez, Samuel Eric Wilson
In the more recent minimally invasive era, we are using laparoscopic and robotic techniques to release the MAL. The well-described natural history of in-stent restenosis with bare metal mesenteric stents has limited their role at our institution where intra-luminal interventions are rarely performed in these patients. In our recent published series, we demonstrated overall early and intermediate clinical improvement rates using robotic and laparoscopic decompression of the MAL alone similar to Dr. Reilly's outcomes with open surgical reconstruction.6 Complete surgical dissection of the celiac ganglion is our primary focus with minimally invasive techniques and has led to excellent symptom relief postoperatively. One possible reason that surgical reconstruction resulted in better long-term outcomes in Dr. Reilly's paper is that a more complete celiac ganglionectomy and exposure of the artery is required for reconstruction or bypass.
The Pancreas and the Periampullary Area
Published in E. George Elias, CRC Handbook of Surgical Oncology, 2020
Pain can be a major problem in over half of the patients with pancreatic cancer. The injection of the splanchnic nerves and celiac ganglion with 6% phenole or 50% alcohol may relieve such pain. Such approaches are carried out percutaneously, at a later date, and preferably not during surgery. This is to avoid hypotensive episodes under general anesthesia.
Management of RSD
Published in Hooshang Hooshmand, Chronic Pain, 2018
The nerve block is done on accessible areas such as the stellate ganglion nerve block for head and upper extremities and lumbar sympathetic ganglion nerve block for lower extremities. Celiac ganglion nerve block is also done quite frequently for abdominal manifestations of RSD. The block is done for both diagnostic and therapeutic purposes.
Spinal cord involvement in Lewy body-related α-synucleinopathies
Published in The Journal of Spinal Cord Medicine, 2020
Raffaele Nardone, Yvonne Höller, Francesco Brigo, Viviana Versace, Luca Sebastianelli, Cristina Florea, Kerstin Schwenker, Stefan Golaszewski, Leopold Saltuari, Eugen Trinka
Fibers originating in the rostroventral nucleus of the medulla that traveling in the Th/IML provide the efferent innervation. Of great importance is also the capacitance of the splanchnic-mesenteric bed. This region is supplied by the splanchnic nerve with cell bodies at the thoracic level and synapses at the celiac ganglion.91 Orthostatic hypotension is a chief complaint in the pure autonomic failure, in LBD and in MSA. Some cases starting as isolated autonomic failure and subsequently developing PD or LBD features were described.71,92,93 Moreover, dysfunctions of cardiac sympathetic and parasympathetic neurons were observed in the initial stages of PD.93 Even is also the genesis of orthostatic hypotension is likely to be multifactorial, the pathology of the dorsal motor nucleus of the vagus may explain the early occurrence of orthostatic hypotension.
Acute intermittent porphyria: general aspects with focus on pain
Published in Current Medical Research and Opinion, 2018
John Lidemberto Cardenas, Carlos Guerrero
Given the sympathetic system and celiac plexus involvement, neurolysis of the celiac ganglion has been performed as an analgesic strategy in patients with refractory neurovisceral pain. Ferrari and Ardengh reported a patient with AIP who was treated with meperidine and whose attacks increased in frequency and intensity; the patient underwent celiac plexus neurolysis with absolute alcohol, with subsequent pain control and opioid medication withdrawal5,11.
Acetylcholine regulates the development of experimental autoimmune encephalomyelitis via the CD4+ cells proliferation and differentiation
Published in International Journal of Neuroscience, 2020
Linli Zhou, Xiuli Lin, Xiaomeng Ma, Yingying Liu, Lili Ma, Zhaoyu Chen, Hao Chen, Lei Si, Xiaohong Chen
Vagus nerve fibers terminate in the celiac ganglion and the neural cell bodies project axons in the splenic nerve to innervate the spleen [52,53]. However, nerve fibers in spleen originating in the celiac ganglion are adrenergic rather than cholinergic and utilize norepinephrine as the primary neurotransmitter [54]. Adrenergic nerve endings in the spleen terminate in the T cell region of the white pulp and norepinephrine secretion can stimulate the terminal transmitter ACh release by T lymphocytes to relay functional information originating in the vagus nerve to spleen [55–57]. That unilateral vagotomy can cause ACh release inhibition in brain has been verified by our experiments earlier. To determine the effect of ACh reduction caused by vagotomy in the spleen, we detected ChAT expression in the splenic cells by flow cytometry. ChAT expression in the splenic lymphocytes was significantly decreased in the vagotomized mice compared with the sham-operation mice, which suggests that unilateral vagotomy can inhibit spleen lymphocyte ACh synthesis. In Rosas-Ballina et al.’s experiments, under stimulation of the spleen CD4+CD44highCD62LlowChAT+ cells with plate-bound CD3-specific antibody, the Th17 cytokine IL-17A, Th1 cytokine IFN-γ significantly increased whereas the Th2 cytokine IL-4 didn’t. This suggests that maybe Th1 and Th17 are the major CD4+ T cells secreting ACh rather than Th2 [57]. In this study, the whole CD4+ T cells in spleen were detected by flow cytometry and showed a decrease in vagotomized mice versus sham-operation mice. Furthermore, consistent with Rosas-Ballina et al.’s study, our results showed that vagotomized EAE mice with reduced spleen CD4+ChAT+ cells revealed a decreased Th1 differentiation, bias to Th2 and increased ChAT+ Th2, which indicates the possibility that the CD4+ T cells expressing ChAT and releasing ACh are more likely to be Th1 rather than Th2. Though both IL-17A and Th17 were reduced in vagotomized mice compared to sham-operation mice, there is no statistical significance. The defined relationships between ACh/ChAT and Th17/Treg still need to be further studied.