The mainstay of surgical therapy for rectal cancer is colectomy (including lesions) with lymph node dissection. The lymphatic spread of rectal cancer can proceed in two directions: medially toward the origin of the inferior mesenteric artery or laterally toward the pelvis aslong the internal iliac artery. To prevent postoperative recurrence, lymph nodes situated along these two axes should be adequately dissected, leaving no residual cancer cells. In Japan, the standard procedure for advanced lower rectal cancer is mesorectal excision and lateral lymph node dissection with autonomic nerve preservation. In Europe and North America, lateral lymph node dissection used to be performed, but it led to increased blood loss, complications, and dysfunction, with no improvement in survival. Lateral lymph node dissection is thus no longer performed. Instead, multidisciplinary therapy combining mesorectal excision with preoperative chemoradiotherapy is now the standard treatment for advanced rectal cancer. Although lateral lymph node dissection decreases the rate of local recurrence similar to preoperative chemoradiotherapy, whether it contributes to improved survival remains unclear. In addition, it is unlikely that prophylactic lateral lymph node dissection is required in all patients with rectal cancer. Definition of the indications for lateral lymph node dissection is thus an important concern.

BACKGROUND:

Patients with chronic whiplash associated disorders (WAD) demonstrate altered central pain processing and impaired endogenous analgesia. In addition, previous research reported disturbances in the autonomic nervous system and the presence of post-traumatic stress reaction in patients with chronic WAD. The autonomic nervous system, in particular the autonomic stress response, might modulate central pain processing in this population.

OBJECTIVES:

The goal of this study was to compare the autonomic response to acute painful stimuli in patients with chronic WAD and healthy controls and to look for associations between endogenous analgesia and autonomic parameters.

STUDY DESIGN:

Case-control study.

METHODS:

Thirty patients with chronic WAD and 31 healthy controls were subjected to an experiment evaluating the autonomic nervous system at rest and during experimental painful stimuli. Skin conductance, heart rate, and heart rate variability parameters were monitored continuously during the evaluation of conditioned pain modulation. The paradigm of heterotopic noxious conditioning stimulation was used to assess this conditioned pain modulation effect.

RESULTS:

The data revealed no difference in autonomic response to pain between chronic WAD and healthy controls. The autonomic response was unrelated to pressure pain thresholds or the effect of conditioned pain modulation in either group.

LIMITATIONS:

The present study only investigates the autonomic response to a stress caused by pain.

CONCLUSION:

Results of this study refute autonomic dysfunction in response to pain in patients with chronic WAD. The autonomic nervous system activity or reactivity to acute pain appears unrelated to either pain thresholds or endogenous analgesia in patients with chronic WAD.

To study movement disorder in Parkinson's disease (PD), an animal model of PD can be created by injecting lipopolysaccharide (LPS) into the substantia nigra of rats. In addition to body movement disorders, patients with PD often experience gastrointestinal (GI) dysfunction, such as gastroparesis. However, the underlying mechanism of these disorders remains unclear. The dorsal motor nucleus of vagus (DMV) is a well-known visceral nucleus that regulates GI function. The present study investigated alterations in DMV neurons and gastric motility in rats with LPS-induced PD (LPS-PD rats). Gastric motility was recorded using a strain gauge force transducer in vivo. The distributions of tyrosine hydroxylase (TH)- and choline acetyltransferase (ChAT)-positive neurons in the DMV were determined using immunofluorescence and confocal laser microscopy. Our results indicated that in LPS-PD rats, the number of neurons in the substantia nigra, including neurons with TH immunoreactivity, was markedly reduced, although glial cell proliferation was clearly observed. However, enhanced TH immunoreactivity and decreased ChAT immunoreactivity were found in the DMV. Furthermore, weakened gastric motility was recorded in anesthetized LPS-PD rats. In conclusion, rats with LPS-induced PD exhibited gastric dysmotility with an alteration in DMV neurons. This PD model may be used to study autonomic nervous system disorders that are often observed in patients with early-stage PD.

AIMS:

In a pilot study we suggested that benfotiamine, a thiamine prodrug, prevents postprandial endothelial dysfunction in people with Type 2 diabetes mellitus. The aim of this study was to test these effects in a larger population.

METHODS:

In a double-blind, placebo-controlled, randomized, crossover study, 31 people with Type 2 diabetes received 900 mg/day benfotiamine or a placebo for 6 weeks (with a washout period of 6 weeks between). At the end of each treatment period, macrovascular and microvascular function were assessed, together with variables of autonomic nervous function in a fasting state, as well as 2, 4 and 6 h following a heated, mixed test meal.

RESULTS:

Participants had an impaired baseline flow-mediated dilatation (2.63 ± 2.49%). Compared with the fasting state, neither variable changed postprandially following the placebo treatment. The 6 weeks' treatment with high doses of benfotiamine did not alter this pattern, either in the fasting state or postprandially. Among a subgroup of patients with the highest flow-mediated dilatation, following placebo treatment there was a significant postprandial flow-mediated dilatation decrease, while this effect was attenuated by benfotiamine pretreatment.

CONCLUSIONS:

In people with Type 2 diabetes and markedly impaired fasting flow-mediated dilatation, a mixed test meal does not further deteriorate flow-mediated dilatation or variables of microvascular or autonomic nervous function. Because no significant deterioration of postprandial flow-mediated dilatation, microvascular or autonomic nervous function tests occurred after placebo treatment, a prevention of the postprandial deterioration of these variables with benfotiamine was not feasible. This article is protected by copyright. All rights reserved.

We report the case of a 38-year-old woman with a history of migraine who experienced an association of recurrent unilateral facial pain and Pourfour du Petit syndrome. The episodes occurred for between a few seconds and up to 3 minutes up to 6 times a day mimicking short-lasting unilateral neuralgiform headaches with cranial autonomic symptoms. No lesional cause was found and the use of topiramate led to a nearly complete disappearance of the episodes. This new entity raises the question of a novel autonomic dysfunction in short-lasting unilateral neuralgiform headaches with cranial autonomic symptoms or an unexpected presentation of migraine.

Background:

The chronic obstructive pulmonary disease (COPD) is associated with the strength and resistance decreasing in addition to the dysfunction on autonomic nervous system (ANS). The aerobic training isolated or in association with the resistance training showed evidence of beneficial effects on an autonomic modulation of COPD; however, there are no studies addressing the effect of isolated resistance training.

Aims:

This study aims at investigating the influence of resistance training on an autonomic modulation through heart rate variability (HRV), functional capacity and muscle strength in individuals with COPD.

Design:

Clinical series study.

Setting:

Outpatients. Population: The study involved 13 individuals with COPD.

Methods:

The experimental protocol was composed by an initial and final evaluation that consisted in autonomic evaluations (HRV), cardiopulmonary functional capacity evaluation (6-minute walk test) and strength evaluation (dynamometry) in addition by the resistance training performed by 24 sessions lasted 60 minutes each one and on a frequency of three times a week. The intensity was determined initially with 60% of one maximum repetition and was progressively increased in each five sessions until 80%.

Results:

The HRV temporal and spectral indexes analysis demonstrates improvement of autonomic modulation, with significant statistical increases to sympathetic and parasympathetic components of ANS representing by SDNN, LF and HF. In addition, it was observed significant statistical increases to shoulder abduction and knee flexion strength and functional capacity.

Conclusion:

The exclusive resistance training performed was able to positively influence the autonomic modulation; in addition it promoted benefits on cardiorespiratory functional capacity and strength benefits in individuals with COPD. Clinical Rehabilitation Impact: This study could contribute to clinical and professionals researchers that act with COPD, even though the resistance component of pulmonary rehabilitation presents consensual benefits on several healthy indicators parameters. There is no evidence about the effects on HRV before. Moreover, this study showed, on clinical practice, the HRV uses as an ANS activity on sinus node evaluation and highlights further importance on scientific context.

The oro-dento-facial features and dysfunction of children with hereditary sensory and autonomic neuropathy type Ill, known as familial dysautonomia or Riley-Day syndrome, was first described in the scientific literature in 1949. They include dental trauma; dental and soft tissue self-mutilation; normal dental age; normal sequence and timing of eruption and exfoliation of teeth; smaller tooth size; different and disproportional tooth components; normal alveolar bone height; small jaws, mild crowding, and malocclusions. These persons have craniofacial morphology that is different from accepted norms but they resemble norms of their ethnic origin. The subjects can have gray, pale, shiny faces with an asymmetric suffering expression; frontal bossing, with eventual hypertelorism and narrow lips; a low caries rate; drooling, and hypersalivation. They can have changes in salivary composition and content, which influences plaque and calculus and increases the risk of gingival and periodontal diseases. They also have difficulty in controlling oral muscles; a progressive decrease in number of tongue fungiform papillae, accompanied by lack of taste buds; and specific dysgeusia, but a normal sense of smell.

We report a 61-year-old man presenting with rapidly progressive stiffness and painful muscle spasms in the lower extremity muscles. The patient was diagnosed with chronic lymphocytic leukaemia (CLL) approximately a year before symptom onset. Electromyography displayed continuous motor unit activity and immunocytochemistry showed a positive staining for antiglycine receptor (anti-GlyR) antibodies. The clinical course was complicated by autonomic instability and cardiac arrest, but stabilised under continuous therapy with plasma exchange and symptomatic treatment with baclofen and clonazepam. Anti-GlyR antibodies induce rare, but severe, variants of stiff person syndrome that can be of paraneoplastic origin and life threatening due to autonomic dysfunction.

The Spontaneously Diabetic Torii (SDT) rat is an inbred strain of Sprague-Dawley rat and recently is established as a nonobese model of type 2 diabetes (T2D). Male SDT rats show high plasma glucose levels (over 700 mg/dL) by 20 weeks. Male SDT rats show pancreatic islet histopathology, including hemorrhage in pancreatic islets and inflammatory cell infiltration with fibroblasts. Prior to the onset of diabetes, glucose intolerance with hypoinsulinemia is also observed. As a result of chronic severe hyperglycemia, the SDT rats develop profound complications. In eyes, retinopathy, cataract, and neovascular glaucoma are observed. Proliferative retinopathy, especially, resulting from retinal neovascular vessels is a unique characteristic of this model. In kidney, mesangial proliferation and nodular lesion are observed. Both peripheral neuropathy such as decreased nerve conduction velocity and thermal hypoalgesia and autonomic neuropathy such as diabetic diarrhea and voiding dysfunction have been reported. Osteoporosis is another complication characterized in SDT rat. Decreased bone density and low-turnover bone lesions are observed. Taking advantage of these features, SDT rat has been used for evaluating antidiabetic drugs and drugs/gene therapy for diabetic complications. In conclusion, the SDT rat is potentially a useful T2D model for studies on pathogenesis and treatment of diabetic complications in humans.

To report a case of Lambert-Eaton myasthenic syndrome (LEMS) in a child and review the existing literature of LEMS in children.We report a pediatric case of LEMS with the classic clinical triad of proximal weakness, autonomic dysfunction, and areflexia; the characteristic increment in compound motor action potential on high-frequency repetitive nerve stimulation; and positive serum P/Q-type voltage-gated calcium channel antibodies. Only 11 pediatric cases of LEMS have been reported in the literature.The patient's presentation with LEMS led to the diagnosis of occult neuroblastoma. Based on review of the existing pediatric literature, no consistent clinical or electrodiagnostic criteria exist to diagnose LEMS in children.There exists a need for consistent clinical criteria and electrodiagnostic testing for prompt diagnosis of LEMS in children. Prompt identification of LEMS will alert the physician to search for malignancy or another immune-mediated process.