Myocardial ischemia (MI) causes somatic referred pain and sympathetic hyperactivity, and the role of sensory inputs from referred areas in cardiac function and sympathetic hyperactivity remain unclear. Here, in a rat model, we showed that MI not only led to referred mechanical hypersensitivity on the forelimbs and upper back, but also elicited sympathetic sprouting in the skin of the referred area and C8-T6 dorsal root ganglia, and increased cardiac sympathetic tone, indicating sympathetic-sensory coupling. Moreover, intensifying referred hyperalgesic inputs with noxious mechanical, thermal, and electro-stimulation (ES) of the forearm augmented sympathetic hyperactivity and regulated cardiac function, whereas deafferentation of the left brachial plexus diminished sympathoexcitation. Intradermal injection of the α₂ adrenoceptor (α₂AR) antagonist yohimbine and agonist dexmedetomidine in the forearm attenuated the cardiac adjustment by ES. Overall, these findings suggest that sensory inputs from the referred pain area contribute to cardiac functional adjustment via peripheral α₂AR-mediated sympathetic-sensory coupling.
Animals ; Ganglia, Spinal ; Hyperalgesia/etiology* ; Myocardial Ischemia/complications* ; Pain, Referred/complications* ; Rats ; Sympathetic Nervous System

BACKGROUND: Laparoscopic cholecystectomy (LC) has traditionally been performed under general anesthesia, however, owing in part to the advancement of surgical and anesthetic techniques, many laparoscopic cholecystectomies have been successfully performed under the spinal anesthetic technique. We hoped to determine the feasibility of segmental epidural anesthesia for LC. METHODS: Twelve American Society of Anesthesiologists class I or II patients received an epidural block for LC. The level of epidural block and the satisfaction score of patients and the surgeon were checked to evaluate the efficacy of epidural block for LC. RESULTS: LC was performed successfully under epidural block, with the exception of 1 patient who required a conversion to general anesthesia owing to severe referred pain. There were no special postoperative complications, with the exception of one case of urinary retention. CONCLUSIONS: Epidural anesthesia might be applicable for LC. However, the incidence of intraoperative referred shoulder pain is high, and so careful patient recruitment and management of shoulder pain should be considered.
Anesthesia, Epidural ; Anesthesia, General ; Cholecystectomy, Laparoscopic ; Feasibility Studies ; Humans ; Incidence ; Pain, Referred ; Patient Selection ; Postoperative Complications ; Shoulder Pain

A clinical study was made on 126 cases of ureterolithiasis during the 5 years period from January, 1976 to December, 1980. The following results were obtained. 1. The incidence of the patients with ureterolithiasis was 8.8% of the total inpatients. 2. There were 92 men and 34 women, a ratio of 2.7:1. The ages of the patients ranged from 18 to 72 years. showing the highest incidence in 21 to 50 years (74.6%). 3. The most frequent location of the ureteral calculi when first seen was the lower third of the ureter in 53.7% of the patients. The ureteral calculi were approximately equally frequent on the left and right sides and bilateral ureteral calculi were found in 4.8%. 4. The most common size of the ureteral calculi was 0.7-1.0 cm in the longitudinal diameter in 43 cases (34.1%). 5. The clinical symptoms of ureterolithiasis were flank pain in 94.4%, hematuria in 14.3%, referred pain in 9.5%, nausea and vomiting in 7.9%, frequency in 7.1% and fever with chillness in 7.1%. 6. Microscopic hematuria was found in 68.9%, pyuria in 27.1% and crystalluria in 15.6%. 7. Increased levels of BUN, creatinine, calcium and uric acid in serum were found in 18.4%, 8.3%, 1.2% and 10.3%, respectively. And leukocytosis was found in 25.5%. 8. Excretory urogram revealed mild hydronephrosis in 28.7%, moderate hydronephrosis in 21.8%, marked hydronephrosis in 10.3%. non-visualization in 11.5%, delayed visualization in 13.8% and nephrogram only in 6.9%. 9. Definite past history of urinary calculi was found in 14 cases (11.1%) and average duration of recurrence was 5.5 years. 10. Treatment consisted of surgical intervention in 71.4%, expectant therapy in 17.6%, instrumental manipulation in 2.4% and spontaneous passage in 8.7%. 11. Postoperative complications occurred in 6 cases (6.7%), i.e., a remnant stone with ureterocutaneous urinary leakage in 2 cases, wound infection in 2 cases, ureterocutaneous urinary leakage in 1 case. unimproved uremia in 1 case. 12. The chemical analysis of 42 ureteral calculi showed the mixed type of calcium oxalate and calcium phosphate in 10 cases (23.8%), calcium oxalate in 7 cases (16.7%),calcium phosphate in 6 cases (14.3%), the mixed type of calcium oxalate and calcium phosphate and magnesium phosphate in 6 cases (14.3%), the mixed type of calcium oxalate and calcium phosphate and uric acid in 3 cases (7.1 %). The major components of ureteral calculi were calcium phosphate and calcium oxalate.
Calcium ; Calcium Oxalate ; Creatinine ; Female ; Fever ; Flank Pain ; Hematuria ; Humans ; Hydronephrosis ; Incidence ; Inpatients ; Leukocytosis ; Magnesium ; Male ; Nausea ; Pain, Referred ; Postoperative Complications ; Pyuria ; Recurrence ; Uremia ; Ureter ; Ureteral Calculi ; Ureterolithiasis* ; Uric Acid ; Urinary Calculi ; Urolithiasis ; Vomiting ; Wound Infection