A thesis submitted to the Faculty of Graduate Studies, University of Medical Sciences, for the master of sciences degree in basic medical sciences (anatomy), 1967.

Zugl.: Giessen, Universiẗat, Diss., 2004.

Zugl.: Giessen, Universiẗat, Diss., 2004.

Th.--Méd.--Reims, 1980. N°: 28.

No description available.

Immunofluorescence was used to study immunoreactivity (IR) for corticotropin-releasing factor (CRF) in the guinea pig enteric nervous system. CRF-IR was expressed in both the myenteric and the submucosal plexuses of all regions of the large and small intestine and the myenteric plexus of the stomach. CRF-IR nerve fibers were present in the myenteric and submucosal plexuses, in the circular muscle coat, and surrounding submucosal arterioles. Most of the CRF-IR fibers persisted in the myenteric and submucosal plexuses after 7 days in organotypic culture. CRF-IR was not coexpressed with tyrosine hydroxylase-IR or calcitonin gene-related peptide-IR fibers. The proportions of CRF-IR cell bodies in the myenteric plexus increased progressively from the stomach (0.6%) to the distal colon (2.8%). Most of the CRF-IR myenteric neurons (95%) had uniaxonal morphology; the remainder had Dogiel type II multipolar morphology. CRF-IR cell bodies in the myenteric plexus of the ileum expressed IR for choline acetyltransferase (56.9%), substance P (55.0%), and nitric oxide synthase (37.9%). CRF-IR never colocalized with IR for calbindin, calretinin, neuropeptide Y, serotonin, or somatostatin in the myenteric plexus. CRF-IR cell bodies were more abundant in the submucosal plexus (29.9-38.0%) than in the myenteric plexus. All CRF-IR neurons in submucosal ganglia expressed vasoactive intestinal peptide-IR and were likely to be secretomotor/vasodilator neurons. CRF-IR neurons did not express IR for the CRF1 receptor. CRF 1-IR was expressed in neuronal neighbors of those with CRF-IR. Collective evidence suggests that VIPergic secretomotor neurons might provide synaptic input to neighboring cholinergic neurons.

Reverse transcription-polymerase chain reaction (RT-PCR), immunohistochemistry, electrophysiological recording, and intraneuronal injection of the neuronal tracer biocytin were integrated in a study of the functional expression of corticotropin-releasing factor (CRF) receptors in the guinea pig enteric nervous system. RT-PCR revealed expression of CRF1 receptor mRNA, but not CRF2, in both myenteric and submucosal plexuses. Immunoreactivity for the CRF1 receptor was distributed widely in the myenteric plexus of the stomach and small and large intestine and in the submucosal plexus of the small and large intestine. CRF1 receptor immunoreactivity was coexpressed with calbindin, choline acetyltransferase, and substance P in the myenteric plexus. In the submucosal plexus, CRF1 receptor immunoreactivity was found in neurons that expressed calbindin, substance P, choline acetyltransferase, or neuropeptide Y. Application of CRF evoked slowly activating depolarizing responses associated with elevated excitability in both myenteric and submucosal neurons. Histological analysis of biocytin-filled neurons revealed that both uniaxonal neurons with S-type electrophysiological behavior and neurons with AH-type electrophysiological behavior and Dogiel II morphology responded to CRF. The CRF-evoked depolarizing responses were suppressed by the CRF1/ CRF2 receptor antagonist astressin and the selective CRF1 receptor antagonist NBI27914 and were unaffected by the selective CRF 2 receptor antagonist antisauvagine-30. The findings support the hypothesis that the CRF1 receptor mediates the excitatory actions of CRF on neurons in the enteric nervous system. Actions on enteric neurons might underlie the neural mechanisms by which stress-related release of CRF in the periphery alters intestinal propulsive motor function, mucosal secretion, and barrier functions.

No description available.

Die Durchführung der interskalenären Plexus brachialis Blockade (ISB)zusätzlich zur Allgemeinanästhesie hat sich bei Operationen im Schulterbereich zur Verbesserung der regionalen Schmerztherapie bewährt. Im Vergleich zum Standardverfahren der Nervenstimulation ist die Verwendung der Sonografie zur Identifizierung des Plexus brachialis eine neuere Methode, die eine direkte Visualisierung der Ziel- und umgebenden Strukturen ohne Notwendigkeit der elektrischen Nervenstimulation ermöglicht. In unserer prospektiven Studie, in die 500 Patienten eingeschlossen wurden, wurden die Methoden "Nervenstimulation", "Sonografie" und die Kombination beider Verfahren hinsichtlich Durchführung, Effektivität, Komplikationen und Patientenzufriedenheit verglichen. Während beide Methoden der ISB-Anlage durchschnittlich in etwa dieselbe Zeit in Anspruch nahmen, traten bei dem ultraschallgestützten Verfahren weniger häufig Schmerzen und Parästhesien auf. Das kombinierte Verfahren nahm deutlich mehr Zeit in Anspruch und löste am häufigsten Parästhesien aus. Der Blockadeerfolg war in der Gruppe „Nervenstimulation“ größer als in der Ultraschallgruppe, wobei der Unterschied nicht signifikant war. Die Effektivität der interskalenären Blockaden, gemessen an der postoperativen Schmerzintensität, der Substanzklasse der ersten Schmerztherapie, der Aufenthaltszeit im Aufwachraum und der Wirkdauer der Nervenblockade zeigte keinen statistisch relevanten Unterschied zwischen den Gruppen. Nur die Zeitdauer von der Freigabe bis zur ersten postoperativen Schmerzmedikation war bei den mithilfe der Nervenstimulation angelegten ISBs signifikant länger als in den beiden anderen Gruppen. Bezüglich des Auftretens von neurologischen oder respiratorischen Komplikationen nach der Blockade sowie hinsichtlich der Patientenzufriedenheit ließ sich kein Unterschied zwischen den Blockadeverfahren nachweisen. Der wichtigste Vorteil der sonogesteurten Technik ist die direkte Visualisierung der anatomischen Strukturen und der Injektion und Verteilung des Lokalanästhetikums. Dadurch können schwerwiegende Komplikationen vermieden werden. Durch den Verzicht auf elektrische Nervenstimulation ist die ISB-Anlage für den Patienten angenehmer. Unsere Ergrebnisse zeigen, dass die sonografisch gesteuerte Anlage von interskalenären Blockaden eine gleichwertige Alternative zur Nervenstimulation darstellt. / Interscalene brachial plexus block (ISB) in addition to general anesthesia is widely used in patients undergoing shoulder surgery to improve the regional pain therapy. The use of ultrasound for identifying the brachial plexus is a new method in comparison to the standardized procedure of nerve stimulation, allowing the direct visualization of the target and surrounding structures without the need of electric stimulation of nerves. In our prospective study including 500 patients we compared the methods “nerve stimulation”, “ultrasound” and “combination of both” in terms of execution, effectiveness, complications and patient satisfaction. While the execution time was comparable in both methods, the ultrasound guidance showed less pain and paresthesia during application of the ISB. The combination of both procedures took statistically longer and caused paresthesia most frequently. The success rate was higher in the group “nerve stimulation” than in the ultrasound-guided ISBs, whereas the discrepancy was not significant. There was no statistically relevant difference in the effectiveness of the interscalene plexus blocks as measured in postoperative pain intensity, drug class of first given pain relievers, stay in anesthetic recovery room and duration of nerve block. Only the time until the first application of pain killers was significantly longer with nerve stimulation. Considering the incidence of postblock neurological or respiratory complications and the patients satisfaction there were no differences between the methods of performing the ISBs. The most important advantage of ultrasound-guidance is the direct visualization of anatomical structures as well as the injection of the local anesthetic and therefore the possibility to avoid major complications. With omission of electric nerve stimulation patient comfort is higher. Our results prove that ultrasound-guided performance of ISBs is an alternative to nerve stimulation.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 6 uppsatser.