The sympathetic trunk and its neural pathway to the upper limb: review of the literature

Zusammenfassung GRUNDLAGEN: Kenntnisse der Anatomie des Truncus sympathicus und des autonomen Nervensystems sind von großer Bedeutung in der Sympathikuschirurgie. Allerdings existiert eine Vielzahl an unterschiedlichen sympathischen Nervenverbindungen zur oberen Extremität, wobei der Großteil im ersten Zwischenrippenraum zu liegen kommt. Aus unterschiedlichsten Gründen führt die chirurgische Sympathektomie im Bereich der oberen thorakalen Ganglien zu einer Unterbrechung der sympathischen Innervation der oberen Extremität. Entscheidend ist, diese variablen Verbindungen zu durchtrennen, um optimale chirurgische Ergebnisse zu erzielen. METHODIK: Diese Arbeit basiert auf einer Durchsicht der Literatur der letzten 80 Jahre über die Anatomie des kranialen thorakalen Truncus sympathicus und seiner Verbindungen, die in der Sympathikuschirurgie von besonderer Bedeutung sind. Die Evaluation basiert auf einer Literaturrecherche in der Medline, ergänzt um Wissen aus Anatomiebüchern; es wird zudem eine Übersicht über die historische Entdeckung des sympathischen Systems gegeben. ERGEBNISSE: Zwei wichtige Ergebnisse liegen vor. 1. Intrathorakale Nervenverbindungen zwischen zweitem und erstem intrathorakalen Nerv dürften sympathische Fasern der oberen Extremität zuführen. Diese Verbindungen kommen bei mehr als 50 % der Menschen vor und dürften für Misserfolge und/oder Rezidive nach Sympathektomie verantwortlich sein. 2. Aktuelle chirurgische Studien weisen darauf hin, dass das Hauptganglion für die sympathische Innervation der oberen Extremität im Segment T4 liegen könnte. Dies steht jedoch im Gegensatz zur bisher anerkannten Ansicht, dass das Hauptganglion der sympathischen Innervation für die obere Extremität das T2-Ganglion sei. Bislang können diese klinischen Erkenntnisse nicht durch anatomisches Wissen erklärt werden. SCHLUSSFOLGERUNGEN: Profunde anatomische Kenntnisse sind eine unabdingbare Voraussetzung, um in der Sympathikuschirurgie optimale Ergebnisse zu erzielen.     

Transesophageal echocardiography in the surgical management of renal cell carcinoma with intracardiac extension.

Renal cell carcinomas may extend into the vena cava and the tumor thrombus occasionally involves the right atrium. The operative approach depends upon precise preoperative and intraoperative staging and thrombus localization. We report a case of renal cell carcinoma with complete inferior vena caval and hepatic vein occlusion with tumor extension into the right atrium. Preoperatively, transesophageal echocardiography provided superior images of the tumor and its extension, and intraoperatively allowed continuous monitoring of cardiac function and the removal of tumor from the atrium and inferior vena cava. Its use obviated the need for more costly and invasive preoperative and intraoperative procedures.     

The Fagerström Test for Nicotine Dependence: a revision of the Fagerstrom Tolerance Questionnaire

We examine and refine the Fagerström Tolerance Questionnaire (FTQ; Fagerström, 1978). The relation between each FTQ item and biochemical measures of heaviness of smoking was examined in 254 smokers. We found that the nicotine rating item and the inhalation item were unrelated to any of our biochemical measures and these two items were primary contributors to psychometric deficiencies in the FTQ. We also found that a revised scoring of time to the first cigarette of the day (TTF) and number of cigarettes smoked per day (CPD) improved the scale. We present a revision of the FTQ: the Fagerström Test for Nicotine Dependence (FTND).     

Seborrheic dermatitis and daylight.

Patients with mood depression have been found to have a higher prevalence of seborrheic dermatitis (SD), possibly related to their tendency to live indoors. The prevalence of outpatients with SD has now been found to be directly related to the number of gloomy days in the area. Since UV light might not be the only reason for the well-known improvement in SD in summer, an explanation possibly related to melatonin is envisaged.     

Use of prolonged sympathetic blockade as an adjunct to surgery in the patient with sympathetic maintained pain

Twenty patients with sympathetic maintained pain (SMP) underwent surgery to treat an associated nerve injury. In each patient, an axillary catheter technique was used to maintain anesthesia and sympatholysis for up to 4 days following surgery. In no instance was the SMP exacerbated by the operation. The use of prolonged sympathetic blockade as an adjunct increases the margin of safety in surgery for these patients when nonoperative measures cannot relieve the pain or restore function.     

Respiratory tract infections due to Branhamella catarrhalis: epidemiological data from Western Australia

During a 3-year period Branhamella catarrhalis was isolated in significant numbers from 239 (1.3%) of 19,488 specimens of sputum sent for routine microbiological examination at a 700-bed general hospital. The majority of patients (83%) were over 60 years of age and 65% were male. There was a distinct seasonal variation in isolations with a peak incidence during the winter and early spring, a pattern not found with other pathogens. Susceptibility to amoxycillin decreased by approximately 50% over the 3 years, corresponding to an increased incidence of beta-lactamase-producing strains. There were minimal changes in susceptibility to other antimicrobial agents. Underlying pulmonary disease was the major factor predisposing to B. catarrhalis infection, and 71% of patients were smokers or ex-smokers.     

Malignancies following long-term azathioprine treatment in chronic liver disease

ABSTRACT— One hundred and fifty-four patients with histologically verified nonalcoholic chronic liver disease were randomized to azathioprine or prednisone treatment. After a median of 91 months observation time, the cause of death was assessed retrospectively. Autopsy was performed in 82% of 71 deaths. In the azathioprine group 33% (13/39) died from malignant neoplasia, and in the prednisone group (13%) (4/32) (p = 0.08). Considering a possible fatal outcome as a consequence of treatment, this finding urges caution in the long-term application of azathioprine at the usual dose level.