A comparative morphologic study of the cardiac innervation in domestic animals I. The canine

Cardiac nerves arising from the cervical and thoracic sympathetic chain, the vagi, and the recurrent laryngeal nerves of the dog were described. The findings are correlated with the nomenclature of the NA ('66) and proposals of the NAV ('67), and additional suggestions are made when appropriate. Although individual cardiac nerves were followed to specific areas of the heart, additional supplies to these areas were noted from the cardiac plexus. Sympathetic cardiac innervation arose primarily from the vertebral ganglion. Cranial vagal cardiac nerves on the left and caudal vagal cardiac nerves on the right contributed the majority of the parasympathetic cardiac innervation. Right cardiac nerves ramified primarily along the right coronary artery, left descending branch of the left coronary artery, circumflex branch of the left coronary artery on the left surface of the heart, and onto the right atrium. Left heart nerves, in addition to their direct contributions to all but the last area, proceeded along the circumflex branch of the left coronary artery on the caudal and right surfaces of the heart. Right nerves contributed more in the area of the S.A node, while left nerves formed a network in the area of the coronary sinus and A.V. node. Both sympathetic and parasympathetic nerves were followed to each area. It was noted that pulmonary innervation via the cardiac plexus would be disturbed by the technique of cardiac denervation referred to as regional neural ablations.     

Topological changes of the human autonomic cardiac nervous system in individuals with a retroesophageal right subclavian artery: two case reports and a brief review

The topological changes of the human autonomic cardiac nervous system in two cadavers with a retroesophageal right subclavian artery (Rersa) were compared with the normal autonomic cardiac nervous system. The following new results were obtained in addition to the conventional deficient finding of the right recurrent laryngeal nerve. (1) Right superior cardiac nerves arising from the superior cervical ganglion were consistently observed in both cadavers, in addition to the right thoracic cardiac nerves along the Rersa. (2) A segmental accompanying tendency of the right cardiac nerves was recognized: the cardiac nerves arising from the sympathetic trunk cranial to the middle cervical ganglia ran along with the right common carotid artery, whereas the cardiac nerves arising from the sympathetic trunk caudal to the vertebral ganglion ran along the Rersa. (3) The right thoracic cardiac nerves, which have never been observed to accompany the normal right subclavian artery, ran along the proximal part of the Rersa. According to previous reports of individuals with the Rersa, a thick right thoracic cardiac nerve is commonly observed instead of a right superior cardiac nerve. However, all the cardiac nerves were recognized in both the individuals described in the present report. Therefore, we strongly disagree with the previous idea that the origin of the right cardiac nerves from the sympathetic trunk and ganglia is shifted caudally in individuals with the Rersa. The topological changes of the autonomic cardiac nervous system in two cases of Rersa also reflected spatial changes of great arteries.     

Occurrence of calcitonin-positive C cells within the distal vagal ganglion and the recurrent laryngeal nerve of the chicken

The chicken ultimobranchial glands are richly supplied with nerve fibers originating from both the main trunk of the vagus nerve and its branch--the recurrent laryngeal nerve. C cells immunoreactive for calcitonin were invariably found in the large nerve bundles distributed throughout the ultimobranchial glands. In addition, these cells were often present within the distal vagal ganglia and the recurrent laryngeal nerves. The frequency of occurrence and the pattern of distribution of the C cells in the distal vagal ganglia and the recurrent laryngeal nerves were determined in chickens of various ages by means of an immunoperoxidase method with anticalcitonin and antineurofilament antisera. The left and right sides of the ultimobranchial region were asymmetrical. The left ultimobranchial gland was in close contact with the vagus nerve trunk, especially with the distal vagal ganglion, but it was separated from the recurrent laryngeal nerve. The right gland contacted the recurrent laryngeal nerves, its medial edge being frequently penetrated by the nerve, but the gland was separated from the distal vagal ganglion. On the left side, C cells were found in 25 out of 39 distal vagal ganglia but they were not distributed in the recurrent laryngeal nerve. On the right side, the cells were present in 28 out of 43 recurrent laryngeal nerves but absent in the distal vagal ganglia. The results indicate that the C cells secreting a hormone calcitonin can enter into nerves, but their occurrence is restricted to the nerves in close proximity to the ultimobranchial glands. Electron microscopic studies revealed that C cells in the nerves received numerous axon clusters enveloped with Schwann cell cytoplasm. Naked axons regarded as axon terminals were found in direct contact with the surface of C cells. They were mainly composed of efferent-type nerve endings showing the accumulation of numerous small clear vesicles and a few large dense-cored vesicles. In addition, C cells were partly covered with the long cytoplasmic processes of Schwann cells and were also in contact with the Schwann cell perikarya. The C cells in nerves appear to be controlled by neural stimulation.     

Functional anatomy of the major cardiac nerves in cats

In recognition of the extensive use of the cat as an experimental model of cardiac innervation, the effects of electrical stimulation of stellate ganglia, thoracic vagosympathetic complexes, and individual feline cardiopulmonary nerves on heart rate, blood pressure, and contractility in all four cardiac chambers were analysed and correlated with the anatomy of the thoracic autonomic nervous system. The right and left stellate ganglia in cats are relatively large and globular. Distinct dorsal and ventral ansae subclavia arise from these ganglia, connecting with the relatively small, spindle-shaped middle cervical ganglia situated in the apices of the thoracic cage bilaterally. A cranial pole nerve arises from each of the middle cervical ganglia and courses cranially to unite with the ipsilateral superior cervical ganglia. On each side, the major cardiopulmonary nerves arise from the middle cervical ganglion, the relatively large vagosympathetic trunk, and the stellate ganglion. On the right side these nerves consist of a very small right stellate cardiac nerve, a recurrent cardiac nerve, a group of craniovagal nerves and a group of caudovagal cardiopulmonary nerves. On the left side are the left stellate cardiac, ventrolateral, ventromedial, and innominate cardiopulmonary nerves. All of these nerves contain efferent parasympathetic and/or sympathetic fibers which modify cardiac chronotropism and/or inotropism. Some contain afferent fibers. These results indicate that specific cardiopulmonary nerves exist in cats, which when stimulated, modify the cardiovascular system in specific fashions.     

Motor neurons of the laryngeal nerves.

The present study was undertaken to determine the relationship between the motor neurons of the superior and recurrent laryngeal nerves within the nucleus ambiguus. The retrograde transport of horseradish peroxidase was utilized to identify the motor neurons subsequent to its application to the proximal transected end of the superior and recurrent laryngeal nerves. Labeled superior laryngeal motor neurons were distributed ventrolaterally in the rostral portion the nucleus. The recurrent laryngeal motor neurons were distributed throughout the nucleus with two distinct populations: a rostral group and a caudal group. The rostral group overlaps the motor neurons of the superior laryngeal nerve. The caudal group occupies that portion of the nucleus that is classically described for the recurrent laryngeal nerve. Additional superior laryngeal nerve labeled perikarya were found in the dorsal motor nucleus of the vagus. This study defines the rostral distribution of the recurrent laryngeal nerve motor neurons and suggests that this rostral group is a component of the neuroanatomical substrate that is involved in the co-activation of the laryngeal abductors controlling the laryngeal aperture.     

Motor neurons of the laryngeal nerves

The present study was undertaken to determine the relationship between the motor neurons of the superior and recurrent laryngeal nerves within the nucleus ambiguus. The retrograde transport of horseradish peroxidase was utilized to identify the motor neurons subsequent to its application to the proximal transected end of the superior and recurrent laryngeal nerves. Labeled superior laryngeal motor neurons were distributed ventrolaterally in the rostral portion of the nucleus. The recurrent laryngeal motor neurons were distributed throughout the nucleus with two distinct populations: a rostral group and a caudal group. The rostral group overlaps the motor neurons of the superior laryngeal nerve. The caudal group occupies that portion of the nucleus that is classically described for the recurrent laryngeal nerve. Additional superior laryngeal nerve labeled perikarya were found in the dorsal motor nucleus of the vagus. This study defines the rostral distribution of the recurrent laryngeal nerve motor neurons and suggests that this rostral group is a component of the neuroanatomical substrate that is involved in the co-activation of the laryngeal abductors controlling the laryngeal aperture.     

Distribution of different regions of cardiac neural crest in the extrinsic and the intrinsic cardiac nervous system.

In this study we focused upon whether different levels of postotic neural crest as well as the right and left cardiac neural crest show a segmented or mixed distribution in the extrinsic and intrinsic cardiac nervous system. Different parts of the postotic neural crest were labeled by heterospecific replacement of chick neural tube by its quail counterpart. Quail-chick chimeras (n = 21) were immunohistochemically evaluated at stage HH28+, HH29+, and between HH34-37. In another set of embryos, different regions of cardiac neural crest were tagged with a retrovirus containing the LacZ reporter gene and evaluated between HH35-37 (n = 13). The results show a difference in distribution between the right- and left-sided cardiac neural crest cells at the arterial pole and ventral cardiac plexus. In the dorsal cardiac plexus, the right and left cardiac neural crest cells mix. In general, the extrinsic and intrinsic cardiac nerves receive a lower contribution from the right cardiac neural crest compared with the left cardiac neural crest. The right-sided neural crest from the level of somite 1 seeds only the cranial part of the vagal nerve and the ventral cardiac plexus. Furthermore, the results show a nonsegmented overlapping contribution of neural crest originating from S1 to S3 to the Schwann cells of the cranial and recurrent nerves and the intrinsic cardiac plexus. Also the Schwann cells along the distal intestinal part of the vagal nerve are derived exclusively from the cardiac neural crest region. These findings and the smaller contribution of the more cranially emanating cardiac neural crest to the dorsal cardiac plexus compared with more caudal cardiac neural crest levels, suggests an initial segmented distribution of cardiac neural crest cells in the circumpharyngeal region, followed by longitudinal migration along the vagal nerve during later stages.     

Extra-segmental reflexes derived from intercostal afferents: phrenic and laryngeal responses

1. Phrenic and recurrent laryngeal efferent responses were evoked by brief tetani or single shocks to the cut external intercostal nerves of anaesthetized cats. The reflexes derived from middle thoracic segments (T5 and 6) were compared with those emanating from caudal thoracic segments (T9 and 10).2. During inspiration, middle intercostal nerve stimulation transiently inhibited the spontaneous discharge in both efferent neurograms, whereas stimulation of caudal intercostal nerves facilitated phrenic discharge and usually inhibited recurrent laryngeal activity.3. During expiration, stimulation at either thoracic level enhanced recurrent laryngeal discharge while provoking little or no phrenic response.4. Superficial lesions of the lateral cervical cord, ipsilateral to the stimulus sites, above or below the phrenic outflow, eliminated all reflex responses except the phrenic response to caudal thoracic stimuli. Similarly, in the spinal animal, middle intercostal afferents could not be shown to decrease phrenic excitability. Caudal intercostal afferents cause phrenic excitation by a spinal reflex.5. Group I afferents of the mid-thoracic segments and group II afferents of the caudal thoracic segments initiate these extra-segmental reflexes.6. The recurrent laryngeal responses manifest, for the most part, changes in the discharge of fibres innervating the posterior cricoarytenoid muscle. The responses fit the overall pattern of response to middle intercostal nerve stimulation, namely, inhibition of inspiratory muscles and excitation of expiratory muscles. Intercostal afferent stimulation also activated the laryngeal adductor muscles.7. The results support the view that intercostal mechanoreceptors initiate an array of extra-segmental respiratory reflexes, including spinal and supraspinal arcs. The simplest way to account for the various responses to stimulation of middle intercostal afferents is to postulate a reflex involving supraspinal respiratory neurones.8. The observed reflexogenic differences correlate with anatomical differences between the middle and caudal ribs. Possible functional implications of this relationship are discussed.     

颈前区器官的应用解剖研究

目的观察颈前区器官与血管和神经的毗邻关系,为临床手术提供解剖学依据。方法在18例36侧成人头颈标本上解剖观测喉、气管颈部和甲状腺的血管和神经的走行及分布。结果甲状腺左、右叶平均长度为48．9±8．8mm和49．9±7．9mm．锥状叶者8例,占44．4％;1例出现甲状腺最下动脉（出现率5．6％）．2例出现甲状腺最下静脉（出现率11．1％）;喉上动脉人喉处在甲状软骨上角的前下方左侧为13．94±2．79mm,右侧为14．93±2．58mm,差异有统计学意义;喉上神经内支人喉处在甲状软骨上角前下方左侧为11．78±3．44mm,右侧为12．26±2．66mm;喉下神经在甲状软骨下角后下人喉,距离甲状软骨下角左侧5．34±1．61mm,右侧5．72±1．74mm,差异有统计学意义。结论手术时应注意这一区域血管神经走行情况,防止并发症的发生。     

Right-Sided Aorta: A cadaver report and brief discussion of human aortic arch anomalies

We observed an unusual right-sided aorta during routine laboratory dissection. The short aortic arch passed to the right side of the esophagus and trachea and had four branches, from proximal to distal: left common carotid, right common carotid, right subclavian, left subclavian arteries. The ligamentum arteriosum connected the pulmonary trunk to the left subclavian artery and lay to the left of the esophagus and trachea. The left recurrent laryngeal nerve passed under the ligamentum arteriosum while the right recurrent laryngeal nerve passed under the aortic arch. The descending thoracic aorta was situated near the midline, anterior to the vertebral bodies; consequently, the right posterior intercostal arteries were shorter than normal. The large veins of the thorax and the other thoracic organs appeared normal.     

Migraine complicated by brachial plexopathy as displayed by MRI and MRA: aberrant subclavian artery and cervical ribs.

This article describes migraine without aura since childhood in a patient with bilateral cervical ribs. In addition to usual migraine triggers, symptoms were triggered by neck extension and by arm abduction and external rotation; paresthesias and pain preceded migraine triggered by arm and neck movement. Suspected thoracic outlet syndrome was confirmed by high-resolution bilateral magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) of the brachial plexus. An unsuspected aberrant right subclavian artery was compressed within the scalene triangle. The aberrant subclavian artery splayed apart the recurrent laryngeal and vagus nerves, displaced the esophagus anteriorly, and effaced the right stellate ganglia and the C8-T1 nerve roots. Scarring and fibrosis of the left scalene triangle resulted in acute angulation of the neurovascular bundle and diminished blood flow in the subclavian artery and vein. A branch of the left sympathetic ganglia was displaced as it joined the C8-T1 nerve roots. Left scalenectomy and rib resection confirmed the MRI and MRA findings; the scalene triangle contents were decompressed, and migraine symptoms subsequently resolved.     

“镂空法”在胸腔镜食管癌根治术中清扫喉返神经旁淋巴结的应用价值

目的 探讨在胸腔镜食管癌根治术中采用“镂空法”行喉返神经旁淋巴结清扫的临床应用价值。方法 回顾性队列研究。纳入2017年1月—2020年6月厦门大学附属第一医院胸外科178例T1~T3期食管癌患者临床资料,其中男105例、女73例,年龄41~78岁。178例患者均采用微创McKeown食管癌切除术治疗,根据术中喉返神经淋巴结的清扫方式不同分为两组:采用传统方法100例纳入传统组,采用 “镂空法”78例纳入镂空组。比较两组患者术中出血量、手术时间、喉返神经旁淋巴结清扫数、术后喉返神经损伤发生率及损伤程度、术后胸腔引流量、食管吻合口瘘及肺部相关并发症。结果 两组患者年龄、性别、肿瘤病灶部位及临床分期等基线资料比较,差异均无统计学意义(P值均＞0.05)。镂空组喉返神经旁淋巴结清扫数目左侧为(5.28±1.77)枚、右侧为(3.33±1.36)枚,传统组喉返神经旁淋巴结清扫数目左侧为(1.79±0.96)枚、右侧为(1.05±0.88)枚;同侧组间比较,镂空组均多于传统组,差异均有统计学意义(t=15.710、12.841,P值均＜0.01)。镂空组78例中,喉返神经损伤共3例(3.85%),其中轻度损伤2例(2.56%)、中度损伤1例(1.28%);传统组100例中, 喉返神经损伤12例(12.00%),其中轻度损伤8例(8.00%)、中度损伤4例(4.00%);镂空组喉返神经损伤的发生率及损伤程度低于传统组,但组间比较差异均无统计学意义(χ²=3.775, Z=-1.936, P值均＞0.05)。 镂空组肺部感染7例(8.97%)、传统组为20例(20.00%),差异有统计学意义(χ²=4.140,P＜0.05)。两组术中出血量、手术时间、术后胸腔引流量及食管吻合口瘘发生率比较,差异均无统计学差异(P值均＞0.05)。结论 在胸腔镜食管癌切除术中采用“镂空法”清扫喉返神经旁淋巴结是安全、可行的,在增加喉返神经旁淋巴结清扫数目的同时不增加喉返神经损伤的发生率。     

Course of the recurrent laryngeal nerve relative to the tracheoesophageal plane and the axis of the trachea

An awareness of the surgical anatomy and the possible dispositions of the recurrent laryngeal nerve (RLN) is helpful in avoiding its injury during thyroidectomy. The relationship of the RLN to the trachea and its course relative to the tracheoesophageal plane were studied in 151 patients undergoing thyroidectomy. One hundred sixty-six (166) nerves were identified, 95 on the right and 71 on the left. Most nerves, both on the right (59%) as well as the left (53.5%), ran posterior to the tracheoesophageal plane. Most right nerves (84.2%) had an oblique course in the frontal plane as related to the tracheal axis or midline (deviation); on the left, most nerves (57.8%) showed no significant deviation. The nerves were found to course from posterior to anterior in the sagittal plane as they ascended the neck in 52.5% of cases on the right (type II obliquity), whereas on the left, 50.7% of the nerves ran in this direction. Approximately 37.2% of the nerves on the right, and 40.8%, on the left, had no obliquity in the sagittal plane paralleling the tracheal axis.     

An anomalous case of the thoracic cardiac nerve in the Japanese monkey

A rare case of an anomalous right thoracic cardiac nerve that directly distributed to the left ventricle and left coronary artery was observed in a Japanese monkey. Its nerve arose from 4th and 5th thoracic ganglia on the right sympathetic trunk, descended obliquely along the thoracic vertebra toward the thoracic aorta at the level of the body of 7th thoracic vertebra. After reaching the aorta, it reflected upward and ascended along the medial-ventral surface of the aorta. Thereafter, it received a cardiac branch arising from the vagus nerve in the upper part of the thoracic aorta, and ran to the left-lateral aspect of the heart. Finally, it gave off main branches to the terminal part of the left coronary artery and the left ventricle, and small branches to the proximal part of the left coronary artery. In a human dissection, similar nerves (the thoracic splanchnic nerve or thoracic pulmonary nerve) originating at the thoracic ganglia and reaching to the lung, have also been observed. The superior, middle and inferior cervical cardiac nerves can easily reach the heart along the common carotid artery, the brachiocephalic artery and subclavian artery. But it is not easy for the thoracic cardiac nerve to reach the heart because of the topographical relationship of its thoracic origin and the peripheral distributions of the left side of the heart. Therefore, the thoracic cardiac nerve would have to run a complicated course.     

与喉手术有关血管神经显微解剖及其临床意义

目的：为减少喉切除等术中的出血、保留正常组织和缩短术后的创面愈合及功能恢复的时间。方法：在手术显微镜下对４０具（８０侧）成人头颈部标本进行解剖测量，着重测量与喉有关的血管和神经。结果：左右侧甲状腺上动脉的长度平均值分别为４２．３，３９．９ｍｍ，起始点的口径平均值均为２．４ｍｍ。左右侧喉上动脉的长度平均值分别为２３．１，２１．６ｍｍ，起始点的口径平均值分别为１．６，１．５ｍｍ，入喉点的口径平均值分别为１．４，１．３ｍｍ。左右侧喉上神经的喉内支入喉点处平均值的宽度和厚度大于左右侧喉返神经入喉点处的宽度和厚度。结论：结果对喉麻痹恢复手术，将来行喉移植手术，以及其他颈部手术均有指导意义。