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

OBJECTIVE: To investigate the effect of bilateral superior cervical sympathetic ganglion occlusion (SCG) on aortic dissection and its possible mechanism. METHODS: Forty-five SD rats were randomly divided into three groups with 15 in each:blank control group, sham operation group and SCG group. β-aminopropione (666 mg·kg·d) was given by subcutaneous injection for 4 weeks to establish the aortic dissection model. Rats in SCG group were given SCG before the injection of β-aminopropione. Blood pressure and heart rate of the rats were monitored using noninvasive tail artery blood pressure measuring instrument; sympathetic activity was monitored using drug block method; the structure of aortic wall was observed using HE staining; collagen fibers in aortic wall was observed using Sirius red staining; protein expression of Apelin was detected by immunohistochemistry; and the protein expression of matrix metalloproteinase (MMP)-2, 9 was detected by Western blotting. RESULTS: During the experiment, the body mass of the sham operation group and SCG group was smaller than that of the blank control group (all <0.05), and the body mass of the SCG group was larger than that of the sham operation group (all <0.05). The heart rate and sympathetic activity of the sham operation group were higher than those of the blank control group (all <0.05), while the SCG group were lower (all <0.05). Compared with the blank control group, the aortic wall in the sham operation group was thickening, while that in the SCG group was improved. A large number of collagen-1 in the aortic wall of the blank control group was stained brown by Sirius red, which was lighter in SCG group, and the staining in the sham operation group was the lightest. Compared with the blank control group, the expression of Apelin, MMP-2 and MMP-9 protein in the sham operation group increased (all <0.05), while those in the SCG group decreased (all <0.05). CONCLUSIONS SCG can effectively reduce the incidence and mortality of aortic dissection in rats, which may be related to the inhibition of sympathetic activity and the decrease of collagen-1, Apelin, MMP-2 and MMP-9 expression.
Aneurysm, Dissecting ; pathology ; surgery ; Animals ; Aorta ; pathology ; Collagen Type I ; Ganglia, Sympathetic ; Random Allocation ; Rats ; Rats, Sprague-Dawley

Ganglioneuroma (GN) is benign neurogenic tumor arising from ganglia of the sympathetic nervous system. They are mostly found at posterior mediastinum, retroperitoneum, and adrenal gland, whereas only 1–5% occurred in the cervical region. GN usually present as a single, painless and slow-growing mass, but multiple cervical occurrences are extremely rare. An 80-year-old woman came to our clinic complained of posterior neck mass for three years. We performed surgical excision, and it was finally diagnosed as GN. We report the unique and rare disease entity with a brief literature review.
Adrenal Glands ; Aged ; Aged, 80 and over ; Female ; Ganglia ; Ganglioneuroma ; Humans ; Mediastinum ; Neck ; Rare Diseases ; Sympathetic Nervous System

Injury to peripheral nerves can lead to neuropathic pain, along with well-studied effects on sensory neurons, including hyperexcitability, abnormal spontaneous activity, and neuroinflammation in the sensory ganglia. Neuropathic pain can be enhanced by sympathetic activity. Peripheral nerve injury may also damage sympathetic axons or expose them to an inflammatory environment. In this study, we examined the lumbar sympathetic ganglion responses to two rat pain models: ligation of the L5 spinal nerve, and local inflammation of the L5 dorsal root ganglion (DRG), which does not involve axotomy. Both models resulted in neuroinflammatory changes in the sympathetic ganglia, as indicated by macrophage responses, satellite glia activation, and increased numbers of T cells, along with very modest increases in sympathetic neuron excitability (but not spontaneous activity) measured in ex vivo recordings. The spinal nerve ligation model generally caused larger responses than DRG inflammation. Plasticity of the sympathetic system should be recognized in studies of sympathetic effects on pain.
Action Potentials ; physiology ; Animals ; Disease Models, Animal ; Female ; Ganglia, Sympathetic ; pathology ; Glial Fibrillary Acidic Protein ; metabolism ; Hyperalgesia ; etiology ; Ligation ; adverse effects ; Macrophages ; pathology ; Male ; Neurogenic Inflammation ; etiology ; Pain ; etiology ; pathology ; Patch-Clamp Techniques ; Peripheral Nerve Injuries ; complications ; Rats ; Rats, Sprague-Dawley ; Receptors, Antigen, T-Cell, alpha-beta ; metabolism

Adjuvant radiation therapy (RT) after colorectal cancer surgery can prevent local recurrence, but has several side effects. Precise injection of drugs into the affected areas is complicated by radiation-induced fibrosis of soft or connective tissue. A 48-year-old woman experienced severe intractable perineal pain, dysuria, urinary urgency, and frequent urination after rectal cancer surgery and adjuvant RT, and was diagnosed with radiation-induced cystitis and vulvodynia. Her symptoms persisted despite two fluoroscopy-guided ganglion impar blocks. Fluoroscopy revealed atypical needle tip positioning and radiolucent dye distribution, presumably due to radiation-induced fibrosis in the target region. We performed two computed tomography (CT)-guided ganglion impar blocks by using a lateral approach, which allowed more accurate po-sitioning of the needle tip. Her pain visual analog score decreased from 9 to 3, and she recently resumed sexual intimacy. CT guidance is a viable alternative to fluoroscopy guidance when performing ganglion impar blocks in fibrotic areas.
Colorectal Neoplasms ; Connective Tissue ; Cystitis* ; Dysuria ; Female ; Fibrosis ; Fluoroscopy ; Ganglia, Sympathetic ; Ganglion Cysts* ; Humans ; Middle Aged ; Needles ; Nerve Block ; Radiotherapy ; Rectal Neoplasms ; Recurrence ; Urination ; Vulvodynia*

The lumbar sympathetic ganglion block (LSGB) is widely used for diagnosing and treating sympathetically maintained pain disorders. The LSGB has been conventionally carried out under fluoroscopy or computed tomography guidance. However, as ultrasound technology improved, ultrasound-guided interventions have been expanding their territory to deeper structures. Ultrasound guidance provides many benefits including protecting vascular injection, shortening procedure time in some cases, and reducing the emission of radiation. In this report, we describe a successful case of a US-guided LSGB without major complications. We expect that US-guided LSGBs can be implemented and furnished in the daily outpatient clinical setting by highly trained pain physicians.
Fluoroscopy ; Ganglia, Sympathetic ; Humans ; Neuralgia ; Outpatients ; Psoas Muscles ; Ultrasonography

Although methidathion is an organophosphate insecticide, it is different from the other organophosphates in terms of toxicity. Because of its relatively high fat solubility, the apparent volume of methidathion distribution throughout the body is very high, indicating that hemoperfusion is not effective in removing this organophosphate from the body. Redistribution of methidathion from fat to blood can also occur when plasma levels diminish. Additionally, acetylcholinesterase aging, which is the loss of an alkyl side chain that prevents reactivation by oximes, is very rapid so that the effective reactivation by oximes is thwarted. Thus, methidathion's effect on acetylcholinesterase inhibition is long lasting, particularly with a high dose. In addition to its parasympatholytic effect and ability to induce muscle paralysis, methidathion poisoning is associated with a profound and long-lasting circulatory collapse due to sympathetic ganglion blockade. This report presents the case of a 55-year-old man who accidentally ingested a high dose of methidathion. He later developed enteroinvasive aspergillosis infection-induced multiple bowel perforations on two separate occasions while on mechanical ventilator support, resulting in a fatal outcome. The renin-angiotensin axis activated by sympathetic ganglion blockade may have reduced the patient's splanchnic blood flow, contributing to translocation of endotoxin. Also, the effect of excessive acetylcholine on non-neuronal acetylcholine receptors may have contributed to the development of fatal enteroinvasive aspergillosis in this patient.
Acetylcholine ; Acetylcholinesterase ; Aging ; Aspergillosis ; Fatal Outcome ; Ganglia ; Ganglia, Sympathetic ; Hemoperfusion ; Humans ; Middle Aged ; Organophosphate Poisoning ; Organophosphates ; Oximes ; Paralysis ; Parasympatholytics ; Plasma ; Poisoning* ; Receptors, Cholinergic ; Shock ; Solubility ; Ventilators, Mechanical

The neck has intricately connected neural structures, including cervical and brachial plexi, the sympathetic system, lower cranial nerves, and their branches. Except for brachial plexus, there has been little research regarding the normal imaging appearance or corresponding pathologies of neural structures in the neck. The development in imaging techniques with better spatial resolution and signal-to-noise ratio has made it possible to see many tiny nerves to predict complications related to image-guided procedures and to better assess treatment response, especially in the management of oncology patients. The purposes of this review is to present imaging-based anatomy of major nerves in the neck and explain their relevant clinical significance according to representative pathologies of regarded nerves in the neck.
Accessory Nerve ; Brachial Plexus ; Cervical Plexus ; Cervical Vertebrae ; Cranial Nerves ; Female ; Ganglia, Sympathetic ; Humans ; Magnetic Resonance Imaging ; Neck* ; Pathology* ; Signal-To-Noise Ratio ; Vagus Nerve

Although methidathion is an organophosphate insecticide, it is different from the other organophosphates in terms of toxicity. Because of its relatively high fat solubility, the apparent volume of methidathion distribution throughout the body is very high, indicating that hemoperfusion is not effective in removing this organophosphate from the body. Redistribution of methidathion from fat to blood can also occur when plasma levels diminish. Additionally, acetylcholinesterase aging, which is the loss of an alkyl side chain that prevents reactivation by oximes, is very rapid so that the effective reactivation by oximes is thwarted. Thus, methidathion's effect on acetylcholinesterase inhibition is long lasting, particularly with a high dose. In addition to its parasympatholytic effect and ability to induce muscle paralysis, methidathion poisoning is associated with a profound and long-lasting circulatory collapse due to sympathetic ganglion blockade. This report presents the case of a 55-year-old man who accidentally ingested a high dose of methidathion. He later developed enteroinvasive aspergillosis infection-induced multiple bowel perforations on two separate occasions while on mechanical ventilator support, resulting in a fatal outcome. The renin-angiotensin axis activated by sympathetic ganglion blockade may have reduced the patient's splanchnic blood flow, contributing to translocation of endotoxin. Also, the effect of excessive acetylcholine on non-neuronal acetylcholine receptors may have contributed to the development of fatal enteroinvasive aspergillosis in this patient.
Acetylcholine ; Acetylcholinesterase ; Aging ; Aspergillosis ; Fatal Outcome ; Ganglia ; Ganglia, Sympathetic ; Hemoperfusion ; Humans ; Middle Aged ; Organophosphate Poisoning ; Organophosphates ; Oximes ; Paralysis ; Parasympatholytics ; Plasma ; Poisoning ; Receptors, Cholinergic ; Shock ; Solubility ; Ventilators, Mechanical

OBJECTIVE: To identify superior cervical sympathetic ganglion (SCSG) and describe their characteristic MR appearance using 3T-MRI. MATERIALS AND METHODS: In this prospective study, we recruited 53 consecutive patients without history of head and neck irradiation. Using anatomic location based on literature review, both sides of the neck were evaluated to identify SCSGs in consensus. SCSGs were divided into definite (medial to internal carotid artery [ICA] and lateral to longus capitis muscle [LCM]) and probable SCSGs based on relative location to ICA and LCM. Two readers evaluated signal characteristics including intraganglionic hypointensity of all SCSGs and relative location of probable SCSGs. Interrater and intrarater agreements were quantified using unweighted kappa. RESULTS: Ninety-one neck sites in 53 patients were evaluated after exclusion of 15 neck sites with pathology. Definite SCSGs were identified at 66 (73%) sites, and probable SCSGs were found in 25 (27%). Probable SCSGs were located anterior to LCM in 16 (18%), lateral to ICA in 6 (7%), and posterior to ICA in 3 (3%). Intraganglionic hypointensity was identified in 82 (90%) on contrast-enhanced fat-suppressed T1-weighted images. There was no statistical difference in the relative location between definite and probable SCSGs of the right and left sides with intragnalionic hypointensity on difference pulse sequences. Interrater and intrarater agreements on the location and intraganglionic hypointensity were excellent (κ-value, 0.749-1.000). CONCLUSION: 3T-MRI identified definite SCSGs at 73% of neck sites and varied location of the remaining SCSGs. Intraganglionic hypointensity was a characteristic feature of SCSGs.
Carotid Artery, Internal ; Consensus ; Ganglia ; Ganglia, Sympathetic* ; Head ; Humans ; Magnetic Resonance Imaging ; Neck ; Pathology ; Prospective Studies