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Influence of Autonomic Nerves on Lymph Flow
Published in Waldemar L. Olszewski, Lymph Stasis: Pathophysiology, Diagnosis and Treatment, 2019
Descriptions of the innervation of the thoracic duct and the cisterna chyli were published in the late 18th century. Wrisberg29 reported that the thoracic duct was supplied mainly by the thoracic ganglion and the left splanchnic nerve. Cruikshank31,32 showed that the thoracic duct was innervated by branches coming from the vagus and the intercostal nerves. Toward the end of the 19th and the beginning of this century there were many studies of the innervation of the thoracic duct and the large lymph vessels.32–35 Most of this early work gives only a general anatomical picture of lymphatic innervation without precise detail of the types of nerves that make up the plexuses in the walls of lymph vessels and their relationship to smooth muscle cells.
Nervous System
Published in Sarah Armstrong, Barry Clifton, Lionel Davis, Primary FRCA in a Box, 2019
Sarah Armstrong, Barry Clifton, Lionel Davis
Ganglia form the sympathetic trunk – a nerve chain that extends from base of skull to coccyx and lies 2–3 cm lateral to the vertebrae Cervical ganglia – superior, middle and inferiorThoracic ganglia – usually 12 to splanchnic and intercostal nervesLumbar ganglia – usually 4Sacral ganglia – usually 4
Head and Neck
Published in Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno, Understanding Human Anatomy and Pathology, 2018
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno
The sympathetic trunk, the superior, middle, and inferior cervical sympathetic ganglia (and cervicothoracic ganglion—or stellate ganglion—a ganglion formed by the inferior cervical ganglion and the 1st thoracic ganglion) are connected by the gray rami communicantes to the cervical spinal nerves. The internal carotid nerve runs from the superior cervical ganglion to the internal carotid artery, as its name indicates (Plate 3.20).
Effect of the relative position of electrode and stellate ganglion during thermal radiofrequency ablation: a simulation study
Published in International Journal of Hyperthermia, 2021
Ramiro M. Irastorza, Maite Bovaira, Carles García-Vitoria, Víctor Muñoz, Enrique Berjano
The stellate ganglion (SG), also known as the cervico thoracic ganglion, is part of the sympathetic nervous system. The SG is a bilateral structure formed by the fusion of inferior cervical and first thoracic sympathetic ganglia in 80% of cases [1], providing sympathetic supply to the head, neck, and upper limbs [2] (see Figure 1). SG blockade by means of local anesthetics has been conducted as a therapeutic intervention for a wide variety of sympathetic-maintained [3] and neuropathic pain syndromes, e.g., for complex regional pain syndrome [1], ventricular arrhythmias [4], cerebral vasoconstriction [5], and cancer pain [6]. Different techniques have been used to block the SG, including local anesthetics, steroids and chemical neurolytic agents (3% phenol in saline, ethanol). Since repeated blocks are sometimes required for patients in whom the effective period is short [3], radiofrequency (RF) ablation (RFA) has been suggested as an alternative to induce irreversible nerve degeneration (i.e., heat-induced neurolysis) and is expected to have a more prolonged effect [7–9]. RFA uses RF power (∼500 kHz) to selectively create a zone of coagulative necrosis in the ablation zone (AZ). In fact, percutaneous RFA of SG may be regarded as a continuous regional sympathetic block with long-term efficiency, improved safety, more precise localization, and less morbidity and mortality than surgical sympathectomy [10].
The role of low-level vagus nerve stimulation in cardiac therapy
Published in Expert Review of Medical Devices, 2019
Yuhong Wang, Sunny S. Po, Benjamin J. Scherlag, Lilei Yu, Hong Jiang
The cardiac ANS, containing both sympathetic and parasympathetic neural elements, can be arbitrarily divided into the extrinsic and intrinsic nervous systems according to the location of the autonomic ganglia and autonomic nerves [10–13]. The extrinsic cardiac ANS is composed of the ganglia along the spinal cord, including the superior cervical ganglia (C1–3), stellate ganglia (C7-T2) and thoracic ganglia (T2-7), as well as their axons connecting with the heart [14]. The intrinsic cardiac ANS is a highly interconnected neural network consisting of autonomic neurons and nerves converging at ganglionated plexi (GP) [14]. The major atrial GPs are typically housed in epicardial fat pads situated in close proximity to the pulmonary veins. GPs function as ‘integration centers’ both in the neural network and between the extrinsic and intrinsic cardiac ANS [15].
Precision medicine in cardiac electrophysiology: where we are and where we need to go
Published in Expert Review of Precision Medicine and Drug Development, 2020
Ashish Correa, Syed Waqas Haider, Wilbert S. Aronow
In general, in patients with LQTS who are treated with beta-blockers but are still symptomatic or have high-risk features, there is a recommendation for intensification of therapy [59,60,95]. This can take the form of expansion of a patient’s drug regimen – potassium supplements or potassium-sparing agents in the case of LQT2 and sodium channel blockers in LQT3 – as described above. But it can also involve surgical anti-adrenergic therapy, i.e. left cardiac sympathetic denervation (LCSD). LCSD is surgical anti-adrenergic therapy wherein the sympathetic nervous supply of the heart is severed to reduce norepinephrine release in the heart, thereby raising the threshold for VF, without affecting the heart rate or contractility [96]. The surgical techniques have evolved over the years and presently, most commonly, the procedure involves the resection of the lower half of the left stellate ganglion and the first four to five left thoracic ganglia. This affords sufficient protection from VF while reducing the risk of Horner syndrome. Perhaps the most important advancement is the utilization of video-assisted thoracoscopic surgery for LCSD, which has resulted in more accurate resection, lower risk of Horner syndrome, lower complication rates and shorter length of stay post-surgery [97,98]. It is indicated for patients receiving maximum tolerated doses of beta-blockers who are still symptomatic, or who are receiving frequent appropriate ICD shocks or in whom ICDs are refused or contraindicated [59]. LCSD is also indicated in patients with high-risk features (LQT2 or 3, age <40, onset of symptoms at age <10 years, and so on).