Celiac Ganglion Research Articles

Accuracy of Endoscopic Ultrasound Imaging in Distinguishing Celiac Ganglia From Celiac Lymph Nodes

Endoscopic ultrasound (EUS) allows visualization of celiac lymph nodes (CLNs) and celiac ganglia (CG). Reliably distinguishing these structures is important for tumor staging and CG ablative therapies. We aimed to evaluate the accuracy of EUS in distinguishing CLNs from CG using a strict cytopathology reference standard. We also determined the rate of detection of CLN and CG by conventional cross-sectional imaging. From EUS and cytopathology databases, we identified all patients who underwent EUS-FNA of a presumed CLN or CG from October 1, 2004, through March 1, 2017, and compared the findings with those from cytology (reference standard). Indeterminate cytology results were re-reviewed. EUS imaging (ie, index test) results were compared with those from the reference standard. An expert radiologist re-reviewed computed tomography and magnetic resonance images from 100 lesions, from 94 randomly selected patients with a reference standard, to determine the rates of CLN and CG detection. A total of 504 patients (mean age, 63.4 ± 13.2 years; 292 men) underwent a median of 7 EUS-FNA passes (range, 1-13) for a total of 566 lesions perceived to be either a CLN or CG; the cytology reference standard was available for 521 lesions (92.1%). When we excluded indeterminate cytology results, the EUS accurately identified 281/286 CLNs (98.3%) and 166/186 CGs (89.2%), for an overall accuracy of 447/472 (94.7%). EUS-FNA distinguished CG from CLNs with a 93.3% sensitivity, 93.7% specificity, a positive predictive value of 96.2%, and a negative predictive value of 89.2%. Of 100 lesions in 94 patients randomly selected for a second expert radiology review, computed tomography and magnetic resonance imaging detected 59/67 CLNs (88.1%) and 13/33 CG (39.4%). EUS accurately distinguishes CLNs from CG. EUS might therefore be used to increase the accuracy of tumor staging, to select tumor stage-appropriate therapy, and to guide CG-ablative therapies.

Vagotomy decreases splenocytes and MHCII+/CD11B+ cells in the spleen

Abstract The Vagus Nerve is a major component, in conjunction with the spleen, in modulating the systemic anti-inflammatory response. Adrenergic fibers of the splenic nerve innervate the spleen, where they stimulate a distinct population of memory T cells. These memory T cells subsequently release ACh, thereby reducing macrophage activation and inhibiting TNFα. Therefore this pathway, as it relates to the spleen, is a two-neuron circuit: initiating first in the dorsal motor nucleus of the Vagus, subsequently synapsing at the celiac ganglion, and finally synapsing on the memory T cells. There are additional lines of evidence demonstrating cholinergic modulation of immune cells in the spleen. For example emerging evidence supports a regulating role of the vagus nerve in mobilizing marginal zone B cells and their subsequent secretion of antibodies, heralding an innate immune response. However, a direct link between splenic B cell number and the vagus nerve has not been previously established. Therefore, we assessed the effects of a left unilateral vagotomy on total splenocytes and MHCII+/CD11+ B cells in the spleen 3 days after vagotomy. Results The results indicate that at 3 days after left unilateral vagotomy, there is a significant decrease in the overall number of splenocytes. The results also show that this vagotomy results in a trend toward a significant reduction in MHCII+/CD11+ B cells in the spleen. Conclusions Our conclusions based upon these results show that there is a direct influence of left vagus nerve innervation on the number of splenic B cells and that left vagotomy results in an overall decrease in either the proliferation of splenocytes in general including the B-cells, or in cell death of splenocytes including the B cells.

Abstract 653: Placental Growth Factor mediates Splenic Sympathetic Overdrive induced by Obesity and induces hypertension

Obesity is an epidemic condition associated with several cardiovascular comorbidities, as hypertension. Although the molecular mechanisms related to obesity-induced hypertension are not well understood, the sympathetic nervous system (SNS) overactivation typically accompanying obesity has been ascribed as one of the main culprits. Thus far, mechanistic studies focused on the effects of sympathetic overdrive on peripheral resistances. Recent data showing that SNS activation also dictates immune responses involved in hypertension, made us hypothesize whether obesity induced by high fat diet (HFD) could recruit splenic SNS efferent. Thus we subjected WT mice to HFD, as compared to low fat diet (LFD), and monitored the hypertensive response. Blood pressure (BP) started to rise after two months, and hypertensive disease became clearly manifest within 4 months. To gain mechanistic insights responsible for BP increase, we assessed peripheral SNS activation at a time point preceding overt hypertension (i.e. 2 months after HFD). We found elevated circulating noradrenalin levels in HFD mice and, more important, a specific pattern of activated splenic sympathetic overdrive, as recorded by microneurography. WT mice subjected by surgical removal of the left celiac ganglion (CGX) where the splenic nerve originate, before receiving HFD, were protected from hypertension, despite developing obesity the same. The fact that splenectomized mice showed an overlapping response to HFD, supported the conclusion that the sympathetic-immune axis is crucial for HFD-induced hypertension but not for weight regulation. To look for molecular determinants, we analyzed the expression of Placental Growth Factor (PlGF), previously identified as a neuroimmune mediator of other hypertensive challenges. PlGF was significantly overexpressed in the spleen upon HFD, but only when SNS innervation was intact, as CGX mice failed to induce its expression. In the end, PlGF KO mice subjected to HFD, although becoming obese as much as WT did, were protected from hypertension. Overall our results demonstrate that a splenic neuroimmune drive is crucial to allow the onset of hypertensive disease associated with obesity, although having no effect in body weight increase in response to HFD.

388 - Prospective, Randomized, Double Blind Clinical Trial of Celiac Plexus Neurolysis and Celiac Ganglia Neurolysis for Pancreatic Ductal Adenocarcinoma: Impact of Secondary Neurolytic Effects on Pain, Quality of Life, and Survival

388 - Prospective, Randomized, Double Blind Clinical Trial of Celiac Plexus Neurolysis and Celiac Ganglia Neurolysis for Pancreatic Ductal Adenocarcinoma: Impact of Secondary Neurolytic Effects on Pain, Quality of Life, and Survival

183 - Prospective, Randomized, Double Blind Clinical Trial of Celiac Plexus Neurolysis and Celiac Ganglia Neurolysis for Pancreatic Ductal Adenocarcinoma: Impact of Total Ganglia Volume on Pain, Quality of Life and Survival

183 - Prospective, Randomized, Double Blind Clinical Trial of Celiac Plexus Neurolysis and Celiac Ganglia Neurolysis for Pancreatic Ductal Adenocarcinoma: Impact of Total Ganglia Volume on Pain, Quality of Life and Survival

The production of nitric oxide in the coeliac ganglion modulates the effect of cholinergic neurotransmission on the rat ovary during the preovulatory period

The aim of the present work was to investigate whether the nitric oxide produced by the nitric oxide/nitric oxide synthase (NO/NOS) system present in the coeliac ganglion modulates the effects of cholinergic innervation on oxidative status, steroidogenesis and apoptotic mechanisms that take place in the rat ovary during the first proestrous. An ex vivo Coeliac Ganglion- Superior Ovarian Nerve- Ovary (CG-SON-O) system was used. Cholinergic stimulation of the CG was achieved by 10−6 M Acetylcholine (Ach). Furthermore, 400 μM Aminoguanidine (AG) – an inhibitor of inducible-NOS was added in the CG compartment in absence and presence of Ach. It was found that Ach in the CG compartment promotes apoptosis in ovarian tissue, probably due to the oxidative stress generated. AG in the CG compartment decreases the release of NO and progesterone, and increases the release of estradiol from the ovary. The CG co-treatment with Ach and AG counteracts the effects of the ganglionic cholinergic agonist on ovarian oxidative stress, increases hormone production and decreases Fas mRNA expression. These results suggest that NO is an endogenous modulator of cholinergic neurotransmission in CG, with implication in ovarian steroidogenesis and the apoptotic mechanisms that take place in the ovary during the preovulatory period in rats.

Alleviating Pancreatic Cancer-Associated Pain Using Endoscopic Ultrasound-Guided Neurolysis.

The most common symptom in patients with advanced pancreatic cancer is abdominal pain. This has traditionally been treated with nonsteroidal anti-inflammatory drugs and opioid analgesics. However, these treatments result in inadequate pain control or drug-related adverse effects in some patients. An alternative pain-relief modality is celiac plexus neurolysis, in which the celiac plexus is chemically ablated. This procedure was performed percutaneously or intraoperatively until 1996, when endoscopic ultrasound (EUS)-guided celiac plexus neurolysis was first described. In this transgastric anterior approach, a neurolytic agent is injected around the celiac trunk under EUS guidance. The procedure gained popularity as a minimally invasive approach and is currently widely used to treat pancreatic cancer-associated pain. We focus on two relatively new techniques of EUS-guided neurolysis: EUS-guided celiac ganglia neurolysis and EUS-guided broad plexus neurolysis, which have been developed to improve efficacy. Although the techniques are safe and effective in general, some serious adverse events including ischemic and infectious complications have been reported as the procedure has gained widespread popularity. We summarize reported clinical outcomes of EUS-guided neurolysis in pancreatic cancer (from the PubMed and Embase databases) with a goal of providing information useful in developing strategies for pancreatic cancer-associated pain alleviation.

68Ga-PSMA-HBED-CC Uptake in Cervical, Celiac, and Sacral Ganglia as an Important Pitfall in Prostate Cancer PET Imaging.

The study aims to investigate the presence of physiologic prostate-specific membrane antigen (68Ga-PSMA)-ligand uptake on PET in cervical, celiac, and sacral ganglia of the sympathetic trunk as a pitfall for lymph node metastases in prostate cancer imaging. Methods: Four hundred seven patients who underwent Glu-NH-CO-NH-Lys radiolabeled with 68Ga-gallium N,N-bis[2-hydroxy-5-(carboxyethyl)benzyl]ethylenediamine-N,N-diacetic acid (68Ga-PSMA-HBED-CC) PET (combined with a diagnostic CT) were retrospectively analyzed. The number of 68Ga-PSMA PET-positive cervical, celiac, and sacral ganglia was determined, and the configuration and SUVmax of each ganglion were measured. In addition, the configuration and SUVmax of adjacent lymph node metastases in the respective region (cervical, celiac, or sacral) were determined. Results:68Ga-PSMA-ligand uptake above background was detected in 401 (98.5%) patients in any peripheral ganglia, in 369 (92%) patients in cervical ganglia, in 363 (89%) patients in celiac ganglia, and in 183 (46%) patients in sacral ganglia. The 68Ga-PSMA-ligand uptake was highest in celiac (mean SUVmax, 2.9 ± 0.8 vs. cervical mean SUVmax, 2.4 ± 0.6) and sacral (mean SUVmax 1.7 ± 0.5; both P < 0.0001) ganglia. Intraindividually there was a statistically significant but weak to moderate correlation between the 68Ga-PSMA-ligand uptake in cervical versus celiac ganglia (R = 0.34, P < 0.0001), cervical versus sacral (R = 0.52, P < 0.0001), and celiac versus sacral (R = 0.16, P < 0.05). The 68Ga-PSMA-ligand uptake was significantly more intense in adjacent lymph node metastases than the respective ganglia (cervical: 18.0 ± 16.2 vs. 2.4 ± 0.6, P < 0.0001; celiac: 13.5 ± 12.3 vs. 2.9 ± 0.8, P < 0.0001; sacral: 13.4 ± 11.6 vs. 1.7 ± 0.5, P < 0.0001). Furthermore, ganglia predominantly exhibit a band-shaped configuration (71.2%), followed by a teardrop (26.8%) and only rarely a nodular configuration (2.0%). Conversely, lymph node metastases are only rarely band-shaped (1.1%), but more often show teardrop (40.3%) or nodular appearance (58.6%) (P < 0.00001). Conclusion:68Ga-PSMA-ligand uptake in ganglia along the sympathetic trunk as assessed by 68Ga-PSMA-HBED-CC PET represents an important pitfall in prostate cancer PET imaging. The 68Ga-PSMA-ligand uptake is higher in celiac ganglia than cervical or sacral ganglia, and the level of 68Ga-PSMA-ligand uptake seems to be patient-related. For the differentiation between lymph node metastases and sympathetic ganglia, both intensity of 68Ga-PSMA-ligand uptake and exact localization and configuration of the respective lesion should be examined carefully.

Effects of sympathectomy on ovarian follicular development and steroid secretion.

Recently, the influence of adrenergic activity over ovarian function, and thus fertility, has begun to gain importance. Previous studies have shown that adrenergic activity through norepinephrine (NE) participates in the control of follicular development and steroidal secretion from the ovary, among other functions. To examine this phenomenon, the denervation of the gonad has been widely used to observe changes in the ovary's performance. Nevertheless, the effect of the absence of adrenergic nerves in the ovary has only been studied in short times periods. In the present work, we used guanethidine (a drug that produces an irreversible sympathectomy) during the infantile period of rats, and we observed its effects in the adult rat (6 months old). Our results indicate that ovarian NE content is recovered at 6 months old, alongside with an increase of the adrenal content of NE and a dysfunctional celiac ganglion. Together, these results suggest that the recovery of ovarian NE does not come from a neural origin. In addition, ovarian performance was impaired because the changes in follicular development and steroidal secretion are not recovered despite the recovery of ovarian NE content. In conclusion, these results suggest that the nerve-ovarian connections, which are established during infantile development, are necessary for the accurate response of the ovary to sympathetic stimulation.

The Experimental Animal Research of Peroral Endoscopic Tunnel Technique in Diagnosis and Treatment of the Diseases Around Abdomen Aorta

Introduction: The emergence of endoscopic tunnel technique makes many diseases which used to need surgical or laparoscopic surgical treatments entered into the endoscopic therapy. The tunnel technique could well prevent the communication between the intra-luminal and the extra-luminal space by sealing the entry incision of the tunnel, gas or fluid within the lumen was prevented from entering the extra-luminal space, which could ensure the endoscopic therapy free of perforation. The procedure is endoscope penetrate from body's natural orifices such as esophagus, gastric, rectum, vagina and so on to body cavity for treatment. But there are few bottlenecks in the development of NOTES. First, it is difficult to close the entrance of natural orifices. Second, the infection which is caused by liquid and air of natural orifices enter into body cavity would occur. Third, it would be lost in body cavity. This research use endoscopic tunnel techniques to perform NOTES in experimental pigs, The tunnel will resolve the problem of closing entrance and infection. Methods: Established an esophagus submucosal tunnel about 5cm long to cardia at the back wall in pigs, Full-thickness myotomy performed and endoscope entered into abdominal cavity through the muscle incision. Exhaust air by puncturing into abdominal cavity. Partial hepatectomy and splenectomy, around the celiac artery ganglion neurolysis, partial tissue resection in the aera of posterior peritoneum were performed. Experimental pigs were prohibited water and diet intake and took antibiotics for 5 days. Their survival situations were observed. Three days later, experimental pigs were executed and were opened to observe the structures of abdominal cavity. Results: Experimental pigs were died after operating splenectomy. Experimental pigs were alive after successfully operating other surgeries. Three days later experimental pigs were executed and were found no injuries in other organs, but adhesion to different degrees of tissues in surgery position. Extensive intra-abdominal endoscopic therapy couldn't be carried out with limit of current endoscopic equipment. Conclusion: Partial hepatectomy and splenectomy, around the celiac artery ganglion neurolysis and partial tissue resection in the area of posterior peritoneum were all successfully performed in experimental animals through endoscopic tunnel technique and the complications were under controlled by internal medicine treatments.

Anchored Down: Diagnostic Pitfalls in the Evaluation of Chronic Nausea and Vomiting

A 20-year-old man with no significant history presented with 2 months of sudden onset but progressively worsening epigastric pain followed by nausea and vomiting. Initially, symptoms occurred only at night, with vomitus containing slightly digested food; they then occurred after small meals as well. There was accelerating weight loss. Physical exam noted fullness of the right abdominal wall. Laboratory testing was unremarkable including hemoglobin A1c. Computed tomography and ultrasound were normal. As esophagogastroduodenoscopy (EGD) revealed retained food, a gastric emptying scan (GES) was performed showing delayed gastric emptying. After an initial diagnosis of gastroparesis, he was managed unsuccessfully by multiple other clinicians. Consequently, alternative diagnoses, including median arcuate ligament syndrome (MALS), were entertained; initial angiography and duplex ultrasound, though, identified no celiac impingement. Given continued suspicion for MALS, celiac ganglion injection was performed with immediate (but temporary) symptom relief. Therefore, definitive surgical decompression was considered. Repeat pre-operative duplex sonography showed celiac artery velocity increasing by 200% with expiration, consistent with MALS. His symptoms completely resolved after his operation. MALS has unclear prevalence given variable presenting symptoms usually associated with other disorders. Confusingly, patients with significant celiac artery stenosis may be asymptomatic. A neuropathic component has also been posited, explaining the patient's improvement with celiac ganglion injection. Operative decompression is generally recommended, at times paired with vascular intervention. Elements of this patient's clinical course reflect common pitfalls of diagnostic testing. Namely, EGD and GES findings caused anchoring bias after the constellation of symptoms was incorrectly interpreted as gastroparesis. Prior clinicians should have found the diagnosis inadequate given the atypical symptom progression and relatively rapid clinical deterioration. Only by recognizing the limitations of routine evaluation for chronic nausea and vomiting was further testing and intervention considered that ultimately yielded the correct diagnosis. This case demonstrates the importance of interpreting diagnostic testing within the patient-specific context. It also reminds us to consider MALS despite its non-specific symptoms given how quality of life can be improved once it is identified.

Injected and Colouring Substances Largely Used in Processing Microscopic Anatomical Structures

There are many fixing and colouring substances largely used in the anatomy laboratories, for teaching purpose. We have injected 22 adult human hearts, removed from the cadavers belonging to the Anatomy and Embryology Department. On 6 specimens we have followed the embryologic myocardium structures for micro angio architecture studies. We used histological techniques like: haematoxylin-eosin, Van Gieson, and Masson�s Trichrome methods. Also we have removed and dissected 14 kidneys and 16 anatomical structures of the peripheral nervous system: coeliac ganglia, aortico renal ganglia and mesenteric ganglia. The least were analyzed using specific techniques of the nervous system: Nissl method and Bielschowsky silver stain method. 8 foetuses (aged between 4 and 8 months of gestation) were dissected and also analysed. Our results were in according to the literature studies.

Dense Intra-adipose Sympathetic Arborizations Are Essential for Cold-Induced Beiging of Mouse White Adipose Tissue

Efferent signals from the central nervous system represent a key layer of regulation of white adipose tissue (WAT). However, the mechanism by which efferent neural signals control WAT metabolism remains to be better understood. Here, we exploit the volume fluorescence-imaging technique to visualize the neural arborizations in mouse inguinal WAT at single-fiber resolution. The imaging reveals a dense network of sympathetic arborizations that had been previously undetected by conventional methods, with sympathetic fibers being in close apposition to > 90% of adipocytes. We demonstrate that these sympathetic fibers originate from the celiac ganglia, which are activated by cold challenge. Sympathetic-specific deletion of TrkA receptor or pharmacologic ablation by 6-hydroxydopamine abolishes these intra-adipose arborizations and, as a result, cold-induced beiging of inguinal WAT. Furthermore, we find that local sympathetic arborizations function through beta-adrenergic receptors in this beiging process. These findings uncover an essential link connecting efferent neural signals with metabolism of individual adipocytes.

Central chemoreflex activation induces sympatho-excitation without altering static or dynamic baroreflex function in normal rats.

Central chemoreflex activation induces sympatho‐excitation. However, how central chemoreflex interacts with baroreflex function remains unknown. This study aimed to examine the impact of central chemoreflex on the dynamic as well as static baroreflex functions under open‐loop conditions. In 15 anesthetized, vagotomized Sprague‐Dawley rats, we isolated bilateral carotid sinuses and controlled intra‐sinus pressure (CSP). We then recorded sympathetic nerve activity (SNA) at the celiac ganglia, and activated central chemoreflex by a gas mixture containing various concentrations of CO 2. Under the baroreflex open‐loop condition (CSP = 100 mmHg), central chemoreflex activation linearly increased SNA and arterial pressure (AP). To examine the static baroreflex function, we increased CSP stepwise from 60 to 170 mmHg and measured steady‐state SNA responses to CSP (mechanoneural arc), and AP responses to SNA (neuromechanical arc). Central chemoreflex activation by inhaling 3% CO 2 significantly increased SNA irrespective of CSP, indicating resetting of the mechanoneural arc, but did not change the neuromechanical arc. As a result, central chemoreflex activation did not change baroreflex maximum total loop gain significantly (−1.29 ± 0.27 vs. −1.68 ± 0.74, N.S.). To examine the dynamic baroreflex function, we randomly perturbed CSP and estimated transfer functions from 0.01 to 1.0 Hz. The transfer function of the mechanoneural arc approximated a high‐pass filter, while those of the neuromechanical arc and total (CSP‐AP relationship) arcs approximated a low‐pass filter. In conclusion, central chemoreflex activation did not alter the transfer function of the mechanoneural, neuromechanical, or total arcs. Central chemoreflex modifies hemodynamics via sympatho‐excitation without compromising dynamic or static baroreflex AP buffering function.

Cytomorphologic Features of Endoscopic Ultrasound-Guided Fine Needle Aspiration of Celiac Ganglia

Cytomorphologic Features of Endoscopic Ultrasound-Guided Fine Needle Aspiration of Celiac Ganglia

Patterns of uptake of prostate-specific membrane antigen (PSMA)-targeted 18F-DCFPyL in peripheral ganglia

ObjectiveRadiotracers targeting prostate-specific membrane antigen (PSMA) have increasingly been recognized as showing uptake in a number of normal structures, anatomic variants, and non-prostate-cancer pathologies. We aimed to explore the frequency and degree of uptake in peripheral ganglia in patients undergoing PET with the PSMA-targeted agent 18F-DCFPyL.MethodsA total of 98 patients who underwent 18F-DCFPyL PET/CT imaging were retrospectively analyzed. This included 76 men with prostate cancer (PCa) and 22 patients with renal cell carcinoma (RCC; 13 men, 9 women). Scans were evaluated for uptake in the cervical, stellate, celiac, lumbar and sacral ganglia. Maximum standardized uptake value corrected to body weight (SUVmax), and maximum standardized uptake value corrected to lean body mass (SULmax) were recorded for all ganglia with visible uptake above background. Ganglia-to-background ratios were calculated by dividing the SUVmax and SULmax values by the mean uptake in the ascending aorta (Aortamean) and the right gluteus muscle (Gluteusmean).ResultsOverall, 95 of 98 (96.9%) patients demonstrated uptake in at least one of the evaluated peripheral ganglia. With regard to the PCa cohort, the most frequent sites of radiotracer accumulation were lumbar ganglia (55/76, 72.4%), followed by the cervical ganglia (51/76, 67.1%). Bilateral uptake was found in the majority of cases [lumbar 44/55 (80%) and cervical 30/51 (58.8%)]. Additionally, discernible radiotracer uptake was recorded in 50/76 (65.8%) of the analyzed stellate ganglia and in 45/76 (59.2%) of the celiac ganglia, whereas only 5/76 (6.6%) of the sacral ganglia demonstrated 18F-DCFPyL accumulation. Similar findings were observed for patients with RCC, with the most frequent locations of radiotracer uptake in both the lumbar (20/22, 90.9%) and cervical ganglia (19/22, 86.4%). No laterality preference was found in mean PSMA-ligand uptake for either the PCa or RCC cohorts.ConclusionAs PSMA-targeted agents become more widely disseminated, the patterns of uptake in structures that are not directly relevant to patients’ cancers must be understood. This is the first systematic evaluation of the uptake of 18F-DCFPyL in ganglia demonstrating a general trend with a descending frequency of radiotracer accumulation in lumbar, cervical, stellate, celiac, and sacral ganglia. The underlying biology that leads to variability of PSMA-targeted radiotracers in peripheral ganglia is not currently understood, but may provide opportunities for future research.

Sympathetic Innervation of Stomach and Spleen: The Role of Coeliac Ganglion in the Chinese Syndromes of Deficiency of Blood and Coldness in Stomach and Spleen as Indications of Pericardium 6

Sympathetic Innervation of Stomach and Spleen: The Role of Coeliac Ganglion in the Chinese Syndromes of Deficiency of Blood and Coldness in Stomach and Spleen as Indications of Pericardium 6

Effect of streptozotocin-induced diabetes on the autonomic ganglia of albino rats

Objectives : One of the common clinical observations regarding long-standing hyperglycemia is autonomic neuropathy, probably due to its unfavorable destructive effects on the neurons of the autonomic ganglia. Accordingly, the current study was aimed to analyze the effect of experimental hyperglycemia on parasympathetic pterygopalatine ganglion (PtG) and sympathetic coeliac ganglion (ClG) of albino rats. Methods: Thirty-six albino rats were divided into six groups (n=6, each) and were designated as control, two weeks, one month, two months, four months and six months groups. Diabetes was induced with a single dose of streptozotocin (STZ, 60 mg/kg, i.p.). Body weight and blood sugar were monitored at biweekly intervals. At the end of each experimental period, animals were euthanized by deep ether anesthesia and blood samples were collected by direct puncture of heart for biochemical analysis. Animals were perfused with Karnovsky fixative. After 48 hours, tissue samples were collected and processed for light microscopy. Results : Biochemical analysis of serum revealed increased serum creatinine and reduced serum total protein. Histopathology and histomorphometry of ganglia revealed that the progressively increasing duration of hyperglycemia was associated with decreased proportion of small-sized neurons, increased proportion of large-sized neurons, dark and dead neurons, and thickening of capsular and endoneurial collagen. Conclusion: The association of the long-standing hyperglycemia with increased neuronal death, altered proportion of neurons and deposition of collagen fibers in autonomic ganglia appear to be important contributing factors likely to be responsible for diabetic autonomic neuropathy.

Uptake in sympathetic ganglia on 68 Ga-PSMA-HBED PET/CT: A potential pitfall in scan interpretation.

The aim of this study was to assess the frequency of PSMA-HBED uptake in coeliac and stellate ganglia in patients presenting for PSMA-HBED PET/CT scan. Prostate-specific membrane antigen-HBED PET/CT scans of 100 consecutive patients were analysed. Coeliac and stellate ganglia were identified by their anatomical location. PSMA-HBED uptake in these ganglia was recorded as either present or absent. If present, the SUVmax value for each ganglion was measured and compared to SUVmax of mediastinal blood pool. Of the 100 patients, 45 had PSMA-HBED uptake in the right coeliac ganglion and 81 had PSMA-HBED uptake in the left coeliac ganglion. The mean SUVmax for the right coeliac ganglion was 2.6 (range 1.2-4.0) and for the left, 2.7 (range 1.2-6.5). An SUVmax 1.5 times greater than that of mediastinal blood pool activity was found in 25 of right and 47 of left coeliac ganglia. Stellate ganglion uptake of PSMA-HBED was identified in 54 of right and 74 of left stellate ganglia. The mean SUVmax for the right and left stellate ganglia were 2.2 (range 1.6-3.6) and 2.4 (range 1.4-4.2) respectively. An SUVmax 1.5 times greater than that of mediastinal blood pool activity was found in 12 of right and 32 of left coeliac ganglia. Uptake in coeliac and stellate ganglia is a frequent finding on PSMA-HBED PET/CT imaging. Often this uptake can be sufficiently high to cause potential diagnostic confusion. It is important to be aware of this physiologic uptake to avoid incorrect diagnosis of metastatic prostate carcinoma.

Celiac block in paediatric patients using endoscopic ultrasound for management of severe pain due to chronic pancreatitis. Review of the technique in 2 cases

Abstract Background Pancreatic diseases such as cancer, idiopathic recurrent pancreatitis, and chronic pancreatitis, can cause pain that is difficult to control. Pain is one of the most debilitating symptoms and demands increasing doses of analgesics and narcotics, as well as the number of hospital admissions, with a direct implication in the costs of medical treatments. Objective To describe the experience with 2 paediatric patients who were subjected to an ultrasound-guided endoscopic celiac ganglion block for difficult pain management, secondary to chronic pancreatitis disease. Clinical cases The first case concerns a 9-year-old male with a diagnosis of chronic pancreatitis, and the second case is a 12-year-old female who developed episodes of intermittent acute pancreatitis. Both cases suffered from chronic abdominal pain, which was difficult to control with stronger painkillers, such as opioids. The pain decreased after patients were subjected to an ultrasound-guided endoscopic celiac ganglion block. Conclusions This technique showed that both patients obtained satisfactory pain relief, with significant improvements in general symptomatology and the stopping of almost all analgesic medication. The authors suggest that celiac ganglion block must be considered, and implemented early before the usual complications, such as a consumption syndrome that is frequent in paediatric patients with chronic pancreatitis.