A. Technology and equipment for the production of beer and soft drinks - Ermolova G.A. The disease is manifested by a triad of symptoms
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MINISTRY OF EDUCATION OF THE RUSSIAN FEDERATION
INSTITUTE FOR THE DEVELOPMENT OF PROFESSIONAL EDUCATION G.A.ERMOLAEVA, R.A.KOLCHEVA
TECHNOLOGY AND EQUIPMENT FOR PRODUCTION OF BEER AND SOFT DRINKS
Textbook
Recommended by the Expert Council on Primary Vocational Education for institutions of primary vocational education
ACADEMA
Moscow
2000
UDC (075.22) BBK 36.87я722 + 36.88я722 E 74
Federal Book Publishing Program of Russia
Reviewer: Chief Specialist of the Ministry of Agriculture and Products G. L. Sviridova
E 74
Ermolaeva G.A., Kolcheva P.A. Technology and equipment for the production of beer and soft drinks: Textbook. for the beginning prof. education. -M.: IRPO; Ed. Center "Academy", 2000. - 416 p. ISBN 5-8222-0118-0 (IRPO) ISBN 5-7695-0631-8 (Publishing center "Academy")
The modern technology for preparing malt, beer, non-alcoholic and low-alcohol drinks, kvass, and mineral waters is considered. The design and operating principle of the technological equipment used, as well as methods of chemical and technological quality control of raw materials and finished products are described. The requirements for raw materials for preparing drinks, process water, containers and auxiliary materials, as well as for the durability and quality of drinks, for industrial sanitation and safe labor practices are outlined.
For students of primary vocational education institutions and engineering and technical workers of brewing and non-alcoholic food industries.
UDC (075.22) BBK 36.87я722 + 36.88я722
© Ermolaeva G.A., Kolcheva P.A., 2000 ISBN 5-8222-0118-0 © Institute for the Development of Vocational Education, 2000
ISBN 5-7695-0631-8 © Design. Publishing center "Academy", 2000
INTRODUCTION
Beer is a sparkling, refreshing drink with a characteristic hop aroma and a pleasant bitter taste, saturated with carbon dioxide (carbon dioxide) formed during the fermentation process. It not only quenches thirst, but also increases the overall tone of the human body and promotes better metabolism.
Brewing is one of the oldest industries. It is assumed that even 7 thousand years BC. In Babylon, beer was brewed from barley malt and wheat. Then the method of making beer spread in Ancient Egypt, Persia, among the peoples inhabiting the Caucasus and southern Europe, and later throughout Europe.
Beer in Rus'. All Slavic languages contain the word “beer”. Previously, this word was used to describe not only beer, but also a drink in general. The words “beer” and “drink” are consonant in Slavic languages. It was the Slavs who were the intermediaries who transferred the practice of using hops to other European peoples.
During archaeological excavations at the site of Ancient Novgorod, birch bark letters were found in which digests were mentioned. Digests are intoxicating drinks made from honey and beer, characterized by high strength. How highly valued digestions were can be judged by the fact that honey and digestions were tribute in Rus'. It should also be noted that beer, malt and hops were part of the peasants' dues for the use of land.
In Rus', beer and meads of various strengths (light - from 2% to 4% alcohol, medium - from 4.5% to 7%, strong - up to 17% and even 35% or more) were ritual drinks consumed at feasts. Beer was brewed in monasteries. During the reign of the great princes, beer was often mentioned in royal decrees. Grand Duke Ivan III during the years of his reign (1462-1505) forbade anyone to brew beer and consume hops, assigning this right to the treasury. The decree was later canceled.
Over time, more and more breweries appear in Rus'. In 1715, at the direction of Peter I, maltsters and brewers were sent to St. Petersburg, which contributed to the development of brewing. The founding of the current brewery in Lviv dates back to the same year. Beer in Rus' is becoming familiar and popular and even appears on the pages of literary works.
At the turn of the XVIII-XIX centuries. Beer from Moscow breweries was famous, the total number of which was 236. Apparently, they were smaller compared to the large St. Petersburg ones. Kaluga beer, produced by top fermentation, was especially famous back then.
The history of St. Petersburg brewing is interesting. In 1795, with the highest approval of Catherine II, Abraham Friedrich Cro-
3
The elder of Russian brewing, a brewery named after Alexander Nevsky, was founded in St. Petersburg. The plant produced up to 170 thousand deciliters per year (1 deciliter or 1 dal equals 10 liters, and 1 hectoliter or 1 hl equals 100 liters) of beer, which was supplied to the imperial table. At the end of the 18th century. Peter Ka-zalet founded beer production near the Kalinkin Bridge. The Kalinkinsky brewery specialized in producing the best, elite varieties of beer. In 1S48, Kron and Cazalet united their factories; later, brewing was carried out at the Kalinkinsky brewery, which already in 1848 produced 330 thousand decalitres. (Since 1923, this plant has been named after Stepan Razin.) In 1863, the Bavaria brewery of the Russian-Bavarian brewing company was established on Petrovsky Island, which became a supplier to the court of His Imperial Majesty. In 1872, the Vienna plant of the Russian-Austrian joint-stock company was founded.
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“A.I. Ermolaeva, G.A. Baranova. AUTONOMIC NERVOUS SYSTEM AND AUTONOMIC DISORDERS. Textbook PENZA 2015 The textbook describes the structure and functions of the autonomic nervous system, ... "
MINISTRY OF EDUCATION AND SCIENCE OF THE RF
Federal state budget educational
institution of higher professional education
"Penza State University" (PSU)
A.I. Ermolaeva, G.A. Baranova.
AUTONOMIC NERVOUS SYSTEM
AND VEGETATIVE DISORDERS.
Tutorial
The textbook describes the structure and functions of the autonomic nervous system, clinical and paraclinical methods for their study, and the main types of autonomic disorders.
The textbook is intended for 3-6 year students of medical universities; it can be used by neurologists, neurosurgeons and doctors of other specialties.
Compiled by:
head Department of Neurology and Neurosurgery, Penza State Medical Institute, Doctor of Medical Sciences A.I. Ermolaeva, Ph.D. Associate Professor of the Department of Neurology and Neurosurgery G.A. Baranova.
Reviewers:
Doctor of Medical Sciences, Professor of the Department of Neurology of the Penza Institute for Advanced Medical Studies of the Ministry of Health of the Russian Federation G.I. Martynova Doctor of Medical Sciences, Professor of the Department of Pharmacy and Pharmacology of the Saratov Medical Institute "REAVIZ" E.V. Verizhnikova Approved and recommended for publication by the methodological and editorial commissions of the Faculty of Medicine of Penza State University.
1. Autonomic nervous system and autonomic disorders…………..4
2. Neurogenic dysfunctions of the pelvic organs….………………………………………………………………………………29
3. Tests……………………………………………………………….33
4. Answers to tests……………………………………………………….38
5. Literature……………………………………………………………..39
AUTONOMIC NERVOUS SYSTEM AND VEGETATIVE
VIOLATIONS
Structure and functions of the autonomic (autonomic) nervous system.Functional role of the ANS:
1. Regulates all internal processes of the body: the activity of internal organs, endocrine glands, blood and lymphatic vessels, maintaining the trophism of all tissues of the body:
2. Provides homeostasis of the body - the constancy of the internal environment and the stability of its basic physiological functions.
3. Provides energy supply for all types of activities.
4. Adaptive-trophic function: regulation of metabolism in relation to environmental conditions. The essence of this function is that it must ensure any deviation in the activity of internal organs in response to changes in the activity of the body. This combination of functions ensures adaptation of the body’s internal environment to constantly changing environmental conditions.
The structure of the autonomic nervous system.
Like the somatic nervous system, the autonomic nervous system is composed of neurons, the basic functional unit being the reflex arc.
The autonomic nervous system is divided into central and peripheral sections (suprasegmental and segmental).
At the segmental level there is a clear division into sympathetic and parasympathetic parts.
The sympathetic part is excited by the neurotransmitter adrenaline, the parasympathetic part by acetylcholine.
The inhibitory effect on the sympathetic part is exerted by the mediator ergotamine; for the parasympathetic - atropine.
All organs are influenced by both the sympathetic and parasympathetic parts of the ANS.
Parasympathetic innervation ensures stable states of organs, and sympathetic innervation applies these states in relation to the functions performed. Both parts of the ANS function in close interaction with each other.
The structure of the sympathetic part of the autonomic nervous system The peripheral part of the sympathetic nervous system begins with neurons of the lateral horns of the spinal cord segments C8-L2. The axons of these cells (myelinated preganglionic fibers) emerge from the spinal cord as part of the anterior roots, then separate and end in the nodes of the border sympathetic trunk. The borderline sympathetic trunk lies on the lateral surface of the bodies of the cervical, thoracic, lumbar, and sacral vertebrae and consists of 3 cervical, 12 thoracic, 5 lumbar, 4 sacral and one coccygeal ganglion. Postganglionic (unmyelinated) fibers go to internal organs, form plexuses around blood vessels, and are part of peripheral nerves. Some of the preganglionic fibers in the nodes of the borderline sympathetic trunk are not interrupted, but go to the intermediate nodes (prevertebral ganglia), which are located between the borderline sympathetic trunk and the internal organs: ganglium coeliacum, ganglium mesentericum, etc.;
the axons of these nodes form autonomic plexuses: solar, mesenteric, etc. and innervate the organs of the abdominal cavity and pelvis.
Each sympathetic node gives off branches to innervate the spine, as well as to the spinal nerves and to innervate internal organs.
The cervical sympathetic nodes innervate the pharynx, larynx, thyroid gland, and give branches to the heart. From the nuclei of the ciliospinal center, located in the lateral horns of segments C8 - D1, fibers in the anterior roots reach the superior cervical sympathetic ganglion, from where the precranial nerve emerges, which forms the plexus of the internal carotid artery (innervates the carotid artery basin). The branches of this nerve, together with the ophthalmic artery, reach the ciliary ganglion, which lies on the optic nerve, from which branches go to the following muscles: m.dilatator pupillae; m.tarsalis superior;
m.orbitalis. When the ciliospinal center, superior cervical ganglion or these fibers are damaged, Horner-Claude Bernard syndrome occurs, which includes a triad of symptoms - ptosis, miosis, enophthalmos.
From the third cervical sympathetic ganglion (stellate), branches emerge to form the cardiac aortic plexus, the vertebral nerve, which forms the plexus of the vertebral artery and accompanies the entire vertebrobasilar region. The cutaneous autonomic innervation of the arm also comes from the third cervical sympathetic node.
Thoracic sympathetic nodes:
the upper six - innervate the organs of the chest (heart, pericardium, trachea, lungs);
the lower six innervate the abdominal organs. The greater and lesser splanchnic nerves pass through the lower thoracic nodes and form the solar plexus.
The lumbar sympathetic nodes give off branches to the formation of the solar plexus (innervation of the kidneys, ureters), and also provide cutaneous autonomic innervation of the leg.
The sacral sympathetic nodes innervate the pelvic organs. When the coccygeal node is damaged, coccydynia syndrome occurs.
– – –
The parasympathetic division of the autonomic nervous system is represented by the craniobulbar and sacral divisions.
The craniobulbar region is represented by the parasympathetic nuclei of the brain stem:
Yakubovich's nucleus - fibers emerge as part of the oculomotor nerve, penetrate into the orbital cavity through the superior orbital fissure, approach the ganglion ciliarae and innervate the muscle that constricts the pupil.
Perlea's nucleus - fibers emerge as part of the oculomotor nerve, penetrate into the orbital cavity through the superior orbital fissure, approach the ganglion ciliarae and innervate the accommodative muscle.
Lacrimal nucleus - fibers emerge as part of the facial nerve in the cerebellopontine angle, leave the skull through the porus acusticus, then, as part of the greater petrosal nerve, reach the pterygopalatine ganglion, reach the lacrimal gland, ensuring its secretion and dilation of the gland's vessels.
Taste nucleus - (nucleus tractus solitarius - nucleus common to the VII and IX pairs of cranial nerves); fibers in the facial nerve, then in the chorda tympani, carry out taste innervation of the anterior 2/3 of the tongue; fibers in the glossopharyngeal nerve innervate the posterior third of the tongue.
Salivatory nucleus (common to the IX, VII pairs of cranial nerves); fibers from the upper portion of the nucleus go as part of the facial nerve, then the chorda tympani and innervate the sublingual and submandibular glands. From the lower portion of the nucleus, fibers in the glossopharyngeal nerve reach the ear ganglion and innervate the parotid gland.
Dorsal nucleus of the vagus nerve (located in the bottom of the rhomboid fossa); the fibers travel as part of the vagus nerve through all organs of the chest, then as part of the solar plexus they innervate the organs of the abdominal cavity.
Sacral section Represented by cells of the lateral horns at the level of segments SII – SIV.
The fibers go to the lower hypogastric plexus on the sides of the rectum, from this plexus emerges the pelvic nerve, which innervates the pelvic organs.
Suprasegmental (central) division of the autonomic nervous system (structure and functions).
Suprasegmental (higher) autonomic centers, the peculiarity of which is the lack of morpho-functional specificity, are located in the cerebral cortex, cerebellum, brain stem, but are mainly represented by structures united under the name of the hypothalamolimbic-reticular complex.
The hypothalamus is the main subcortical center for the integration of autonomic functions. Its anterior border is formed by the posterior edge of the optic chiasm, the posterior - the caudal edge of the mammillary bodies, the lateral - the hypothalamus, the cerebral peduncles and the internal capsule. The hypothalamus forms the base of the brain, representing the bottom of the third ventricle and includes the posterior parts of the chiasm, the gray tubercle, the infundibulum of the gray tubercle, and the mastoid bodies.
Highlight:
the ergotropic system, which includes the posterior sections of the hypothalamic region, ensures physical and mental activity through the segmental sympathetic apparatus (increases blood pressure, improves gas exchange, pulmonary ventilation, blood supply to working muscles);
the trophotropic system, which includes the anterior sections of the hypothalamic region, associated with the rest period, slow phase sleep, mobilizes the vagoinsular apparatus (lowers blood pressure, slows the heart rate, narrows the bronchi, increases intestinal motility).
The hypothalamus is the highest vegetative center, the place of coordination of the nervous, endocrine, and humoral regulation of the vital functions of the body. The hypothalamic region has connections with all parts of the nervous system. Afferent pathways go to the hypothalamus from the cortex, from the extrapyramidal system, from the visual thalamus, and sensory organs.
Efferent pathways from the hypothalamus go to the visual thalamus, to the reticular formation of the brainstem, and the subcortical nuclei of the EPS, to the parasympathetic nuclei of the brainstem. The hypothalamus is also closely connected with the pituitary gland.
The hypothalamic region is divided into the following sections:
anterior section - (includes medial and lateral preoptic nuclei, supraoptic nucleus, paraventricular nuclei and anterior hypothalamic nucleus), provides control of parasympathetic innervation, water-salt metabolism;
middle section - (includes the serotuberous nuclei), ensures the regulation of all types of metabolism;
posterior section - (includes the medial and lateral mammillary bodies, posterior hypothalamic nucleus), provides control of sympathetic innervation.
The centers of the hypothalamus are neither sympathetic nor parasympathetic; they carry out integral regulation of the functions of both parts of the autonomic nervous system.
The hypothalamus plays an important role in regulating the function of internal organs. This regulation can be carried out either directly or through the endocrine glands. The cells of the supraoptic and paraventricular nuclei of the anterior hypothalamus are connected to the posterior lobe of the pituitary gland and provide the production of vasopressin (supraoptic nucleus) and oxytocin (paraventricular nucleus). Vasopressin regulates water metabolism, and oxytocin causes contraction of the pregnant uterus.
The cells of the parvocellular nuclei of the ventral hypothalamic region are associated with the anterior lobe of the pituitary gland, the adenohypophysis. They produce neurohormones (releasing factors), which enter the portal vasculature of the pituitary stalk and reach the anterior pituitary gland.
There are 7 hypothalamic factors that affect the glandular formations of the adenohypophysis. Of these, 5 factors stimulate the release of corticotropic, thyroid-stimulating, somatotropic, luteinizing, follicle-stimulating hormones and 2 factors are inhibitory: one inhibits the release of prolactin, the other melanocystostimulin.
In addition, the hypothalamus contains centers related to the regulation of fat, water-salt, carbohydrate metabolism, body temperature, sweating, behavioral reactions (sexual desire, thirst, appetite), emotions (fear, aggression, euphoria).
The hypothalamic region is highly vascularized (1200 capillaries per 1 mm). Numerous vessels of the hypothalamic region are highly permeable to large molecular protein compounds, this contributes not only to high sensitivity, but also to the penetration of infectious agents, toxins, and hormones. This causes the hypothalamic region to be highly sensitive to various physiological and pathological influences.
All activities of the ANS are controlled and regulated by the cortical parts of the nervous system (mediobasal parts of the frontal temporal lobes, parietal lobes). The hypothalamus is closely connected to the limbic system.
The limbic system includes the formations of the olfactory pathways located at the base of the brain, the hippocampus, the dentate gyrus, the septum pellucida, the amygdala, and the anterior nuclei of the hypothalamus. The limbic system is of great importance in emotional reactions, attention, memory, and regulates sleep and wakefulness. Therefore, any impact on the structures of the hypothalamus or limbic system is accompanied by a complex set of reactions of many body systems, expressed in mental and visceral effects.
Of all the structures of the brain stem, a significant role in the regulation of autonomic functions is played by the reticular formation, the nuclei of which form suprasegmental centers for the regulation of vital functions:
respiration, cardiac activity, metabolism, vasomotor and a number of others.
RETICULAR FORMATION
Anatomically, the reticular formation of the trunk, as shown by 1 itself.The name represents a network-like formation consisting of scattered fibers and cells.
2. The structure of the cells that make up the RF is “mixed”, simultaneously having signs of both Goldie type I and II. These cells are located in different parts of the Russian Federation with different densities and differ in size, which served as the basis for identifying a significant number (over 40) of nuclei in it.
3. The length of the RF trunk along the length corresponds to the length of the trunk from the caudal brain to the oral part of the midbrain.
4. Efferent connections of the reticular formation:
a) descending system – reticulospinal. It begins in the pons and goes to the anterior and lateral columns of the spinal cord.
b) long ascending fibers of the RF are sent to the interstitial and telencephalon, ending in the thalamus optic, striatum, hypothalamic region, septum pellucidum and preoptic region. They originate mainly in the medial part of the reticular formation.
c) in addition, the efferent fibers of the RF are sent to the cerebellum, originating in the lateral and paramedial nuclei, as well as in the tegmental nucleus of the ankylosing spondylitis bridge.
5. Afferent connections of the reticular formation:
a) spinoreticular fibers passing through the spinal cord in the anterolateral columns. They end in the RF of the medulla oblongata and the pons.
b) cortico-reticular fibers arise in various parts of the cerebral cortex. Among them, the predominant fibers are those arising in the sensorimotor area of the cortex. They end in those cell groups in which the reticulospinal and reticulocerebellar tracts originate.
c) cerebellar-reticular fibers arise in various cerebellar nuclei and end in different formations of the Russian Federation.
d) cellular elements of the Russian Federation receive fibers from the nuclei of sensory cranial nerves, sensory systems passing through the trunk to the cerebral hemisphere.
e) hypothalamic-reticular fibers, arising in various parts of the hypothalamic region and ending in the oral part of the trunk.
6. Within the Russian Federation, there are also semi-specialized formations that are closely related to the Russian Federation, formed on the basis of its neurons and regularly carrying out blood circulation and respiration:
a) vasomotor center. Inside it there are depressor and pressor centers. The depressor center, the effect of stimulation of which is a decrease in blood pressure, is localized in the lower parts of the giant cell reticular nucleus and the reticular nucleus of the medulla oblongata. In these zones there are neurons that directly project to the spinal cord.
The pressor center is located rostral to the depressor center. It also distinguishes accelerator and inhibitory centers, irritation of which leads to a change in heart rate (stimulation of the first is accompanied by tachycardia, and the second by bradycardia).
b) Respiratory center. The expiratory and inspiratory centers are located in the zone of the giant cell reticular nucleus.
7. The reticular formation, being an important integrative formation (for the implementation of mainly somato-vegetative interaction during wakefulness and sleep), is only part of more global integrative systems, including limbic and non-cortical structures, in interaction with which the organization of purposeful behavior is carried out.
HYPOTHALAMUS.
1. In humans, the hypothalamus consists of gray matter and the nuclei located in it. They are divided into three zones: preoptic, tuberal and mamillian.
2. The main nuclei of the hypothalamic region are as follows:
a) supraoptic nucleus,
b) three groups of nuclei of the gray tuberosity,
c) mamillo-infundibular nucleus,
d) pallido-infibular nucleus lying in the middle part of the gray tuberosity.
e) introphricate nucleus lying between the crura of the fornix.
e) paraventricular nucleus.
g) connecting nucleus, lying in the middle commissure (III ventricle).
h) paramedian nucleus.
i) nucleus of the mamillary body.
3. The rest of the mass of the hypothalamic region consists of scattered elements, smaller than in the cell nuclei of the gray matter, which are a direct continuation of the reticular formation of the trunk.
4. Afferent connections of the hypothalamus:
a) the hypothalamic region receives a powerful bundle of fibers from the forebrain - the medial forebrain bundle.
b) fibers of the terminal cavity enter the hypothalamus, through which communication is made with the ammon's horn, pyriform lobe and tonsils.
c) the visual afferent system is encircled, the fibers of which follow from the optic nerves and chiasm to the hypothalamus.
d) a bundle of fibers coming from the globus pallidus to the hypothalamus.
e) the hypothalamus receives fibers from the fornix that arise in the hippocampus and end in the mamillary bodies.
f) the experiment describes the connections of the hypothalamus with the midbrain. The fibers of this system arise in the anterior part of the RF of the midbrain and end in almost all parts of the hypothalamus.
g) in addition, fibers from the spinal cord come to the hypothalamus, interrupted in the nuclei of the columns of the medulla oblongata.
5. Efferent connections of the hypothalamus:
a) a bundle of fibers starting in the supraoptic, paraventricular and tuberous nuclei of the hypothalamus and ending in the pituitary gland (hypothalamypophyseal tract),
b) the Vic D'Azir bundle connects the mamillary bodies with the anterior nucleus of the optic thalamus,
c) the long descending systems of the hypothalamus connect the hypothalamus with the reticular formation of the brainstem,
d) diffuse ascending systems connect the posterior hypothalamus with the basal-frontal and olfactory structures of the cerebral cortex,
e) connections of the mamillary bodies with the cerebellum.
6. Inside the hypothalamus, specific nuclei and nonspecific structures are distinguished.
7. The specific ones include formations projecting onto the pituitary gland, the effect of irritation and destruction of which is strictly specific, and a distinctive feature of the neurons of these nuclei is neurocrinia. Thus, in particular, antidiuretic hormone (ADH) is formed in the supraoptic and paraventricular nuclei, which descends along the axons of the hypothalamic-pituitary tract to the posterior lobe of the pituitary gland. In other specific nuclei, they form releasing factors, which enter the adenohypophysis and regulate the secretion of tropic hormones (ACTH, gonadotropic, somatotropic, etc.).
8. The remaining parts of the hypothalamus (with the exception of specific receptors that perceive changes in the internal environment of the body - osmo-, glyco-, and tetmoreceptors) cannot be considered specific. The responses obtained when they are irritated depend, first of all, on the parameters of the irritated agent. They are included, on the one hand, in the limbic system, on the other, they are a continuation of the reticular formation of the brain stem, essentially its most oral department.
9. A feature of the hypothalamus is also the special sensitivity of its neurons to changes in the internal environment, such as a decrease or increase in blood sugar levels, hormone concentrations, and osmotic balance.
10. Thus, the hypothalamus contains (with the exception of its specific sections) not individual functions, but coordination synergies.
The subcutaneous region is one of the links in integration systems, a relatively specific feature of which is neurohumoral coordination, analysis of humoral changes, and inclusion of the hormonal system in the organization of adaptive behavior.
11. The hypothalamus regulates metabolism, thermoregulation, and is related to the organization of sleep and wakefulness, and emotions.
LIMBIC SYSTEM.
STRUCTURE of the limbic system. It includes the following anatomical formations:1. Hippocampus.
2. Mamillary bodies.
3. Girdle gyrus.
4. Transparent partition.
5. Anterior nucleus of the visual thalamus.
6. Amygdala complex (amygdala and fence).
7. Piriform gyrus.
8. Olfactory tubercles.
9. Olfactory tracts.
Limbic system connections:
Afferent - impulses follow in the LS mainly from the reticular formation of the trunk, hypothalamus, thalamus opticum and from various parts of the cortex.
Efferent connections - with the cortex (all its departments), with subcortical formations, thalamus optic, hypothalamus and reticular formation of the trunk.
Neural circuits within the limbic system:
Greater circle of Peipitz – hippocaipus – fornix – nucleus transparent 1.
septa – mamillary bodies – anterior nucleus of the thalamus – cingulate gyrus.
Lesser circle of Peipitz - amygdala complex - hypothalamus.
Segmental circle of Nauta – septum – supracallosis 3.
plates – hippocampus – fornix – septum.
Functions of the limbic system:
1. Regulation of the constancy of the internal environment of the body through the creation of appropriate neurovisceral control complexes.
2. Participation in the implementation of emotions.
3. Organizing daily acts or motivations
4. memory organization.
5. Takes part in the regulation of sleep and wakefulness.
6. Takes part in the regulation of cerebral activity.
Signs of damage to the limbic system:
Violation of visceral reactions - manifestations along the gastrointestinal tract, arterial hypertension, anginal cardiovascular paroxysms.
Emotional disorders - states of false rage and 2.
aggressiveness, symptoms of lack of fear and aggressiveness (shown in the experiment). With tumors of the temporal lobe, symptoms may be observed - lack of fear, aggressiveness, complacency, pronounced hypersexuality, increased oral exploratory automatisms.
Violation of motivation – a disorder of complex behavioral acts 3.
(anatomical ambulatory syndromes, lack of initiative).
Memory disorders – difficulty reproducing traces, 4.
difficulty remembering, there may be manifestations of Korsakoff's syndrome.
Psychomotor epileptic seizures are typical 5.
psychosensory, visceral and other sensory auras.
Akinetic mutism syndrome (“waking coma”) – absence of 6.
impulses for motor acts, including speech production (with open eyes and maintaining tracking movements of the eyeballs).
EMOTIONS AND MOTIVATIONS.
When considering the problem of physiology and pathology of EMOTIONS andMOTIVATIONS The following must be kept in mind:
1. In Russia, the biological theory of emotions by P.K. Anokhina.
2. this theory was created by P.K. Anokhin based on his own original general physiological theory of functional systems.
The functional system, according to Anokhin, is a branched, self-regulating central-peripheral organization that, on the basis of constant reverse afferentation, provides one or another adaptive result that is important for the body.
3. P.K. Anokhin proceeds from the fact that life is a chain of events consisting of two stages: a) the emergence of needs and drives and b) their satisfaction.
4. Emotions are nothing more than a determination of the body’s needs and the likelihood of its satisfaction at the moment.
5. Human emotions always carry certain adaptive effects (adaptation to an external situation or internal motivations).
6. When a need arises, a person first experiences a negative emotion (since at the time the need arises, it is not yet satisfied).
7. An appropriate mechanism arises in the body, which provides the necessary reaction to meet the need.
8. If a need or desire is satisfied, the emotion is positive.
9. Some emotions and motivations are genotypically determined as a certain form of response. These shapes are stored in memory.
10. The action program (to satisfy the need) is adopted on the basis of afferent synthesis and analysis of memory traces.
11. The complex process of afferent synthesis includes: a) multisensory type of convergence on neurons, b) multibiological type - perception of complex biological functions (hunger, pain, orientation, etc.), c) sensory-biological type - combination of receptor and biological ones on the same neurons stimuli, d) axonal-sensory-biological type - connection of previous and efferent neurons.
All this happens at the level of cortical-subcortical structures related to the system of afferent synthesis.
12.To realize emotions, complex types of synthesis are included. After a decision is made, a model of action is developed that determines human behavior.
13. After the action is carried out, there is a reverse afferentation into the action acceptor, a comparison of the program and the result occurs, a comparison of the need and the degree of its satisfaction. The more complete the coincidence, the more positive the emotion.
14. If the need and the result of the action do not coincide, a negative emotion arises, a new program is adopted - a new action, etc. until a coincidence (positive emotion) occurs.
15. Currently, the prevailing opinion is that there is no cruel localization of emotional centers. It is believed that the corresponding functional systems, which can change during the course of individual life, are created and overlap in accordance with the specific environment and living conditions of the individual. Human emotions are understood as the experience of one’s relationship to the surrounding reality and internal state.
16. A person has two main mechanisms for registering emotions: a) internal experience (sphere of mood), b) external expression of emotions - facial expressions, gestures, vasomotor play.
Emotion is very closely related to motivation (drive and drive)
1. Motivation characterizes those actions that are determined by the internal needs of a person.
2. The hypothalamus contains a number of specialized cells that can subtly detect changes in the parameters of the internal environment. Here the transformation of chemical irritation (arising in response to changes in parameters) into a nerve impulse occurs.
3. The distribution of impulses from the cells of the hypothalamus to the reticular formation, limbic system and cortex leads to the organization of peculiar behavior of humans and animals, aimed at searching in the external environment for the corresponding stimulus necessary to eliminate the excess or inflammation of the deficiency of the corresponding substances in the body.
4. Evaluation of the result of the action performed leads to a certain emotional state depending on the degree of satisfaction.
5. After comparison in the action acceptor, when the program and action coincide, emotional consolidation of motivation occurs and this is recorded in memory. Subsequently, when a similar situation is repeated, this emotional memory is a kind of guiding path of motivation (a kind of appetite for this type of action).
6. Motivations are divided into a) empty (primary), which are fixed by hereditary mechanisms (hunger, sexual desire, fear, etc.) and are based on unconditioned reflex reinforcement and b) higher, which are based on conditioned reflex reinforcement and are associated with training and education .
There is an even higher level of motivation (purely human type) associated with the social factor (patriotism, heroism, etc.).
7. In motivation itself, three stages are distinguished: a) attraction (formed at the level of afferent synthesis) - it turns out what the body needs now, b) purposeful action. There are many drives, but at each stage the most important functional system is selected - the dominant one (usually either hereditarily programmed or fixed on the basis of individual experience), c) reinforcement - that external stimulus that is sought by the body (to effect changes in the latter).
Clinical methods for examining the autonomic nervous system.
The complex of studies of the autonomic nervous system includes two groups of methods: the first allows one to assess the condition of the suprasegmental part, the second allows one to assess the condition of the segmental part. The study of the suprasegmental department includes the determination of autonomic tone, reactivity and support of activity. The condition of the segmental department is assessed by the level of functioning of the internal organs and physiological systems of the body. In this case, it is determined which part of the autonomic nervous system (sympathetic or parasympathetic) is affected and which parts of it (afferent or efferent) are affected.
The study of vegetative status consists of three groups of indicators:
1. Study of the initial autonomic tone.
Autonomic tone is the degree of tension (basal level of activity) in the functioning of a particular organ (heart, lungs, etc.) or physiological system (cardiovascular, respiratory, etc.) in a state of relative rest. It is determined by impulses entering the organ from postganglionic sympathetic and parasympathetic fibers. Autonomic tone is influenced by segmental and suprasegmental autonomic centers. The influence of segmental autonomic centers determines the tone within the system, and suprasegmental ones - in the body as a whole. To determine the autonomic tone of the body, you need to evaluate the tone in each of its systems.
Methods for studying autonomic tone include special questionnaires, tables and objective research data. In the process of targeted questioning of patients, attention is drawn to a tendency to chills, allergic reactions, dizziness, nausea, and palpitations.
The duration and depth of night sleep, emotional background, and performance are assessed. During an objective examination, signs such as the size of the pupils and palpebral fissure, skin color and temperature, body weight, arterial systolic and diastolic pressure, and pulse rate are recorded.
A study of the function of the thyroid gland, adrenal glands, and blood glucose levels is carried out using stress tests.
ECG indicators are assessed.
Signs of the predominance of the activity of the sympathetic department are: tachycardia, increased blood pressure, mydriasis, pallor and dry skin, pink or white dermographism, loss of body weight, periodically occurring chill-like hyperkinesis, superficial anxious sleep, increased content of catecholamines and ketosteroids, increased pulse rate, detection of ECG shortening of the R-R, PQ intervals, increase in the R wave and flattening of the T wave.
The predominance of the tone of the parasympathetic part of the autonomic nervous system is manifested by bradycardia, hyperemia of the skin, hyperhidrosis, hypotension, red elevated dermographism, increased drowsiness, a tendency to allergic reactions, decreased blood glucose levels, and a relative decrease in thyroid function. The ECG reveals sinus bradycardia, an increase in the RR, P-Q intervals, widening of the QRS complex, a shift of the ST segment above the isoline, an increase in the T wave and a decrease in R.
For the quantitative relationship between sympathetic and parasympathetic manifestations, a number of calculated indicators are proposed, for example, the Kerdo vegetative index:
BP diast.
VI= 1 Pulse
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Symptoms and Parasympathetic Sympathetic reactions reaction indicators Skin color Pallor Tendency to hyperemia Vascular pattern Not expressed Increased, cyanosis Greasiness Normal Increased Dryness Increased Normal Sweating Decreased (if the sweat is viscous, then Increased (liquid sweat) is increased) Dermographism Pink, white Intense red, raised Skin temperature Decreased Increased Pigmentation Increased Reduced Body temperature Increased Reduced Cold tolerance Fair Poor Heat tolerance Poor, heat intolerance Fair Body weight Tendency to lose weight Tendency to increase Appetite Increased Decreased Pupils Dilated Normal Palpebral fissures Dilated Normal Pulse Labile tachycardia i Bradycardia BP (systolic and Increased Decreased or normal diastolic) ECG Sinus tachycardia Sinus bradycardia Dizziness Uncharacteristic Frequent Respiration rate Normal or rapid Slow, deep Salivation Decreased Increased Composition of saliva Thick Liquid Gastric acidity Normal or reduced Increased juice Intestinal motility Atonic constipation, weak Dyskinesia, spastic peristalsis constipation, diarrhea Urination Polyuria, light urine Urgent urges Pilomotor reflex Strengthened Normal Allergic reactions Absent Tendency (swelling, itching) Temperament Increased excitability Lethargy, inactivity Sleep Short, poor Drowsiness Physical Increased Decreased performance Mental sphere Absent-mindedness, inability to focus attention on anything satisfactory, one thing, activity higher in the evening activity higher in the first half of the day Number of red blood cells Increased Decreased Number of leukocytes Increased Decreased Blood glucose level Increased, normal Decreased (hypoglycemia) Hunger tolerance Normal Poor Reaction to ultraviolet radiation Normal, decreased Strengthened Orthostatic test Pulse relatively accelerated Pulse relatively slow Clinostatic test Pulse relatively slow Pulse relatively accelerated Aschner test Normal, paradoxical acceleration Significant slowing of pulse rate
2. Study of autonomic reactivity.
Autonomic reactivity is determined by the speed and duration of changes in vegetative parameters in response to irritation from the external or internal environment. Research methods include pharmacological tests using adrenaline and insulin and physical exercise.
The following tests are most often used in clinical practice:
The oculocardiac reflex (Danyini-Aschner) involves pressing on the eyeballs, as a result of which in healthy individuals the heart rate slows down by 6-12 per minute. If the number of contractions slows down by 12-16, this is regarded as a sharp increase in the tone of the parasympathetic part. The absence of a slowdown or acceleration of heart contractions by 2-4 per minute indicates an increase in the excitability of the sympathetic part.
Solar reflex - with the patient lying on his back, the examiner applies pressure with his hand on the upper abdomen until a pulsation of the abdominal aorta is felt. After 20-30 seconds, the number of heartbeats slows down in healthy individuals by 4-12 per minute. Changes in cardiac activity are assessed as in the oculocardiac reflex.
Cold test - with the patient lying down, the heart rate is counted and blood pressure is measured. After this, the hand of the other hand is immersed for 1 minute in cold water at a temperature of 4°, then the hand is removed from the water and blood pressure and pulse rate are recorded every minute until it returns to the original level. Normally this happens within 2-3 minutes. When blood pressure increases by more than 20 mmHg. the reaction is assessed as pronounced sympathetic, less than 10 mmHg. as moderate sympathetic, and with a decrease in pressure - as parasympathetic.
Orthoclinostatic reflex - the study is carried out in two steps.
With the patient lying on his back, the number of heartbeats is counted, and then he is asked to quickly stand up (orthostatic test).
When moving from a horizontal to a vertical position, the heart rate increases by 12 per minute with an increase in blood pressure by 20 mmHg. When the patient moves to a horizontal position, pulse and pressure indicators return to their original values within 3 minutes (clinostatic test). The degree of pulse acceleration during an orthostatic test is an indicator of the excitability of the sympathetic part of the autonomic nervous system. A significant slowdown of the pulse during a clinostatic test indicates an increase in the excitability of the parasympathetic part.
Pilomotor reflex - the “goose bump” reflex is caused by pinching or applying a cold object (a test tube of cold water) or a cooling liquid (cotton wool soaked in ether) to the skin of the shoulder girdle or the back of the head. On the same half of the chest, “goose bumps” appear as a result of contraction of smooth hair muscles. The reflex arc closes in the lateral horns of the spinal cord, passes through the anterior roots and the sympathetic trunk.
Test with acetylsalicylic acid - with a glass of hot tea, the patient is given 1 g of acetylsalicylic acid. Diffuse sweating appears. If the hypothalamic region is damaged, its asymmetry may be observed. When the lateral horns or anterior roots of the spinal cord are damaged, sweating is disrupted in the area of innervation of the affected segments. When the diameter of the spinal cord is damaged, taking acetylsalicylic acid causes sweating only above the site of the lesion.
Test with pilocarpine - the patient is injected subcutaneously with 1 ml of a 1% solution of pilocarpine hydrochloride. As a result of irritation of postganglionic fibers going to the sweat glands, sweating increases. It should be borne in mind that pilocarpine stimulates peripheral Mcholinergic receptors, causing increased secretion of the digestive and bronchial glands, constriction of the pupils, increased tone of the smooth muscles of the bronchi, intestines, gall and bladder, and uterus.
However, pilocarpine has the most powerful effect on sweating. If the lateral horns of the spinal cord or its anterior roots are damaged in the corresponding area of the skin, sweating does not occur after taking acetylsalicylic acid, and the administration of pilocarpine causes sweating, since the postganglionic fibers that react to this drug remain intact.
Light bath - warming the patient causes sweating. The reflex is spinal, similar to the pilomotor one. Damage to the sympathetic trunk completely eliminates sweating due to pilocarpine, acetylsalicylic acid and body warming.
3. Vegetative support of activities is carried out using modeling of various types of activities:
Physical – dosed physical activity, bicycle ergometry, dosed walking, dosed squatting;
Mental - counting in the mind;
Emotional – modeling negative or positive emotions.
Autonomic reactions are assessed by changes in pulse, respiration, blood pressure, ECG indicators, and rheoencephalogram.
Since the hypothalamic region regulates all types of metabolism, they study indicators characterizing water-salt, carbohydrate, fat, protein, mineral metabolism, study the function of the endocrine glands, the thyroid gland, the function of the ovaries, and study the level of tropic hormones of the pituitary gland.
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Syndromes of damage to the segmental part of the ANS.
When the segmental part of the ANS is damaged, sympathalgia often occurs, which is characterized by:
1) pain is burning, cutting, pressing;
2) is associated with temperature, increases with heat and decreases with cooling;
3) paroxysmal, intensifies with changes in weather, emotional stress;
4) the localization of pain does not correspond to the zones of innervation of peripheral nerves;
5) combined with changes in pain sensitivity of a vegetative nature: hyperalgesia, hypalgesia with hyperpathia, unclear boundaries of sensitivity disorders;
6) vascular pain on palpation;
7) the presence of vasomotor disorders: skin hyperemia, pallor, pastiness.
The entire complex of autonomic manifestations that occur when the segmental (peripheral) part of the ANS is damaged is called peripheral autonomic failure (PVF).
Primary peripheral autonomic failure is a chronic, slowly progressive disease. They are based on degeneration of segmental autonomic apparatus, often in combination with a degenerative process in other structures of the nervous system (parkinsonism, cerebellar disorders, damage to the peripheral nervous system). For example, Shy-Drager, Riley-Day, Bradbury-Eagleston syndrome. The main symptom is loss of peripheral vascular resistance, which is manifested by orthostatic hypotension.
Secondary peripheral autonomic failure is formed against the background of a current somatic or neurological disease.
Manifests itself in the following clinical forms:
1. Damage to the lateral horns of the spinal cord (vegetative disorders are combined with damage to other structures);
2. Damage to the sympathetic nodes of gangliopathy, reflex sympathetic dystrophy;
3. Damage to postganglionic autonomic fibers: autonomic neuropathies, autonomic polyneuropathies, perivascular plexopathies;
4. Damage to the segmental department with impaired vascular innervation:
Raynaud's disease and syndrome, erythromelalgia, erythrosis, Quincke's edema, angioneurosis;
5. Damage to the autonomic plexuses: autonomic plexopathies;
6. Damage to the segmental department with the involvement of suprasegmental departments: causalgia, phantom pain, reflex paralysis, contractures, hyperkinesis, reflex sympathetic dystrophy.
Clinical characteristics of the main forms of damage
1. Damage to the lateral horns of the spinal cord can occur with syringomyelia, vertebrogenic myelopathy, spinal cord tumors, and inflammatory lesions of the spinal cord. It manifests itself as vascular, trophic, sensory, secretory, visceral disorders according to the level of damage, combined with signs of damage to sensory and motor pathways.
2. Damage to the sympathetic nodes occurs during inflammatory adhesive processes in the chest and abdominal cavities, traumatic injuries, and infectious diseases.
According to the level of innervation, patients experience skin symptoms in the form of vascular disorders (redness or pallor of the skin, cold temperatures, warming), pilomotor disorders, atrophy of the skin and subcutaneous tissue, and impaired sweating.
Visceral disorders are observed: damage to the abdominal organs, pelvis, pain in the heart area without changes on the ECG (not relieved by coronary drugs), pain in the pelvic area, muscle symptoms in the form of muscle atrophy and hypotonia, pain (sympathalgia) of a vegetative nature, sensitivity disorders . Mental disorders in the form of melancholy, anxiety, and fear are characteristic. When the cervical sympathetic nodes are damaged, Horner's syndrome or Petit's syndrome occurs.
3. Damage to the autonomic plexuses.
The most common lesion is the solar plexus - solaropathy.
Etiology: chronic traumatization of the plexus due to enteroptosis, external mechanical injuries, aortic enlargement, neoplasms, infections (malaria, syphilis, influenza, typhus), inflammatory diseases of internal organs (cholecystitis, duodenitis, gastric and duodenal ulcers), intoxication (alcohol, diabetic , lead), helminthic infestations.
Clinic: pain not associated with eating, in the epigastric region with irradiation into the chest, girdling pain, accompanied by fear of death and anxiety. Outside of an attack, depression and a hypochondriacal state are observed. The pain can be constant and in the form of crises, accompanied by an increase or decrease in blood pressure, constipation or diarrhea, and vomiting. Similar symptoms may occur when other plexuses are affected.
4. Damage to postganglionic autonomic fibers.
It is observed with damage to peripheral nerves containing a large number of autonomic fibers (these are the sciatic, tibial, median, trigeminal nerves). If vegetative symptoms come to the fore, then a vegetative form of neuritis is diagnosed. For example, with neuritis of the sciatic nerve, burning pain occurs in the innervation zone with symptoms of hyperpathy, an increase or decrease in skin temperature, paleness of the foot, fingers, dry skin, and in the future there may be trophic ulcers.
If there is multiple symmetrical damage to the peripheral nerves in the distal parts of the extremities and pain, vascular, and trophic disorders predominate, then autonomic polyneuropathy is diagnosed. The cause may be more than 100 etiological factors; it is more common in alcoholic and diabetic polyneuropathy.
When the choroid plexuses of individual arteries are damaged, perivascular plexopathy occurs. For example, vertebral artery syndrome with cervical osteochondrosis.
5. Damage to the segmental part of the ANS with impaired vascular innervation.
Angiotrophoneurosis is a group of diseases that arise as a result of disorders of the vasomotor and trophic innervation of organs and tissues.
Raynaud's disease and syndrome Damage occurs to the autonomic centers that regulate vascular tone (vasomotor centers), resulting in the development of vascular spasm. Women get sick more often.
Raynaud's symptom complex can manifest itself as an independent disease and as a syndrome in various diseases: collagenosis, especially scleroderma, lesions of the cervical spine, systemic vascular diseases, vibration disease, ergot intoxication.
The disease manifests itself as a triad of symptoms:
1) paroxysmal vegetative-vascular disorders;
2) symmetry of autonomic disorders;
3) the presence of trophic disorders.
The attack consists of 3 phases:
1) paleness of the fingers (lasts 5-20 minutes) – a spasm of the capillaries occurs, paresthesia and burning are characteristic.
2) blueness of the fingers (lasts up to 1 hour) - spasm of arterioles and dilation of capillaries occurs.
3) redness of the fingers - atony of arterioles and capillaries occurs.
First, the arms are affected, then the area of the nasolabial triangle, and legs.
Differential diagnosis between the disease and Raynaud's syndrome:
Disease Syndrome
1. The appearance of symptoms under the influence of 1. Spontaneity of occurrence.
hypothermia, psycho-emotional agitation.
2. Symmetry of the lesion. 2. Asymmetry of the lesion.
3. Relatively favorable course for 3. Early onset of complications.
for several years, long absence of gangrene.
Erythromelalgia.
Weir-Mitchell disease. It can occur as a syndrome after malaria, trauma, frostbite, with multiple sclerosis, myxedema, and mercury poisoning. It often develops over the age of 40.
Irritation of the parasympathetic part of the ANS is important in pathogenesis. Clinically characterized by the occurrence of paroxysmal pain in the evening and at night in the feet, especially in 1 toe, swelling in the distal parts of the legs, a feeling of heat, redness of the skin, dilated veins, increased pulsation of the arteries, an increase in skin temperature in the area of edema by 2-4°. Subsequently, trophic disturbances appear in the form of vesicles, pustules, and the process spreads to the hands, nose, and ears. Pain sensations sharply increase when the limb is warmed, standing, walking and, conversely, significantly decrease in the cold, while lying down. The attack lasts from several minutes to several hours.
Erythrosis - redness of the distal parts of the extremities with mild trophic disorders, without pain.
Quincke's edema - occurs as a reaction to specific external irritants, allergens. Characterized by persistent paralytic changes in the vessels, accompanied by an increase in vascular permeability.
Swelling of tissues and subcutaneous tissue develops on a small surface, most often the pharynx, larynx, and face.
6. Damage to the segmental department with the involvement of suprasegmental structures (reflex sympathetic dystrophy).
Causalgia occurs when a limb is injured with damage to nerves rich in autonomic fibers: median, tibial.
Damage to the nerve trunk causes irritation of afferent vegetative fibers, impulses are transmitted to the cells of the lateral horns, dorsal horns, then, as part of bundles of superficial and deep sensitivity, they reach the visual thalamus and the parietal region.
Therefore, with causalgia there is a peripheral focus of irritation in the nerve and a focus of irritation at the level of the visual thalamus. Causalgia occurs two weeks after injury and can last up to 14 years.
Clinic:
1. Intense burning pain localized in the skin, painful sensations of dry skin (the “wet rag” symptom is characteristic).
2. Inconsistency between the localization of pain and the zone of innervation of the affected nerve.
3. Pain decreases when cooling and increases when warming.
4. The presence of vasomotor, secretory, trophic disorders in the affected area.
When the process generalizes, the following symptoms are characteristic:
1. Increased pain with loud sounds, excitement, light stimuli;
2. Changes in the patient’s behavior and psyche;
3. Formation of painful contractures;
4. Senestalgia - spread of pain to secondary causal fields (for example: spread of pain from the left hand to the right hand).
Phantom pain is intense, varied sensations in the amputated limb.
Syndromes of damage to the central part of the ANS Hypothalamic syndromes arise due to disruption of the production of releasing factors and neurotransmitter metabolism.
Etiological factors of hypothalamic damage:
infections (flu, rheumatism, tonsil intoxication);
1) allergic factors;
2) traumatic brain injury;
3) intoxication - medicinal, industrial;
4) inflammatory diseases of internal organs of the type 5) repercussion;
psychogenic (due to connections with the limbic system);
6) vascular diseases of the brain (hypertension 7) disease, atherosclerosis, vasculitis).
Often it is not possible to detect brain damage; in this case, there is a constitutionally determined biochemical defect in hypothalamic regulation, which can decompensate during various critical periods: puberty, pregnancy, menopause.
The formation of the brain is also influenced by the presence of diseases in the parents, the nature of childbirth, the degree of full term, and occupational hazards.
Hypothalamic syndromes are a combination of autonomic, endocrine, and trophic disorders caused by damage to the hypothalamus. The presence of neuroendocrine disorders is mandatory for the diagnosis of hypothalamic syndrome.
Clinical classification of hypothalamic syndromes.
1. Neuro-endocrine-metabolic syndrome: diabetes insipidus, hypothalamic obesity, Itsenko-Cushing's disease, Babinsky-Froelich syndrome, acromegaly, persistent galactorrhea-amenorrhea syndrome, Morgagni-Stuart-Morel syndrome.
2. Violation of thermoregulation: hyperthermia (permanent, paroxysmal), hypothermia, chill-like hyperkinesis, chill syndrome.
3. Myasthenic-like neuromuscular syndrome;
myopathic;
myathon-like;
myoplegic.
4. Neurotrophic syndrome, including malignant exophthalmos, changes in hair growth, osteoporosis, atropathies, gastrointestinal ulcers.
5. Sleep and wakefulness disorders: hypersomnic conditions, narcolepsy, Pickwick's syndrome, periodic hibernation syndrome, hypothalamic insomnia.
6. Psychopathological syndrome: depressive, hypochondriacal, neurasthenic.
7. Autonomic-vascular-visceral syndrome is characterized by the occurrence of crises (sympatho-adrenal, vagoinsular, mixed vegetative-visceral).
8. Hypothalamic epilepsy: characterized by a stereotypic structure of the vegetative-vascular-visceral crisis, disturbance of consciousness of varying degrees, tonic convulsions.
General principles of treatment for lesions of the segmental part of the ANS. Etiotropic therapy is indicated if vegetative syndrome develops against the background of an acute period of any disease. For example, an acute period of an infectious disease.
The main type of therapy is pathogenetic.
When prescribing pathogenetic therapy, it is important to analyze the clinical picture of the disease: identifying signs of damage or inhibition of one or another part of the ANS.
If there are symptoms of irritation of sympathetic formations, it is advisable to prescribe:
To reduce sympathoadrenal activity, central sympatholytics (reserpine 0.1 3 times a day),
Neuroleptics (aminazine 0.025 once a day, sonapax, dopegit 0.25 3 times a day), adrenoblockers (phentolamine, pyrroxane, dihydroergotamine, nicergoline), adrenoblockers (anaprilin, visken).
2) Ganglion blockers: benzohexonium, pentamin (to avoid orthostatic complications, use in small doses, per os).
3) Vasodilators (antispasmodics papaverine, nicotinic acid, no-spa);
4) Tranquilizers: relanium, phenazepam, elenium, mezapam;
5) Sedatives: bromine, motherwort, valerian root;
6) For severe sympathalgia, use finlepsin, tegretol;
7) For causalgia, neuroleptics, analgesics, carbamazepine drugs are prescribed, but not narcotics!;
8) Mixed-action drugs – belloid, bellaspon, bellataminal;
9) General agents: mild maritime climate, carbon dioxide, radon, hydrogen sulfide baths;
10) Physiotherapeutic processes in case of damage to the segmental part of the autonomic nervous system are carried out on the affected limb and segmentally in the projection of the affected sympathetic nodes (for example, in case of Raynaud's disease, ultraviolet radiation, DDT, electrophoresis with calcium, novocaine, phonophoresis of hydrocortisone, mud are prescribed to the arms and cervical region paravertebrally applications of low temperature (37°), electrophoresis with novocaine on the epigastric region for solaropathy);
11) IRT (inhibitory method);
12) Novocaine blockades (perivascular, perineural blockades, blockades of sympathetic ganglia, solar plexus);
13) Surgical methods of treatment (desympathization, preganglionic sympathectomy);
14) X-ray therapy on sympathetic nodes for Raynaud's disease.
To reduce parasympathetic tone:
Monoamine oxidase inhibitors (ephedrine);
Tranquilizers;
Anticholinergics (cyclodol, tropacin, belladonna preparations);
Antihistamines (diphenhydramine, tavegil, betaserc, pipolfen);
Low-calorie diet;
Pine baths;
IRT (stimulating method).
In case of insufficient sympathetic tone:
Adrenergic agonists: adrenaline, ephedrine.
Drugs that stimulate the nervous system: caffeine, phenamine, 2.
calcium preparations, ascorbic acid, glutamic acid, ginseng extract, Chinese lemongrass.
A diet with plenty of protein.
Mountain climate, cool showers, salt and radon baths.
Symptomatic therapy: analgesics, tranquilizers.
Psychotherapy.
Treatment of Raynaud's disease.
Vasoactive antispasmodics (no-spa, complamin, nicotinic acid).
Neuroleptics (aminazine).
Ganglion blockers (Novocaine 0.5% intravenously).
Sympatholytics, adrenergic blockers (phentolamine, tropafen, reserpine, 4.
dopegyte, sermion); adrenergic blockers are not used, as they cause spasm of peripheral vessels).
ACE inhibitors (captopril, enalapril).
Agents that improve the rheological properties of blood (trental, chimes, 6.
verapamil, corinfar, cordafen).
7. To normalize the synthesis of prostaglandins and reduce red blood cell aggregation, NSAIDs (methindol, piroxicam) are used.
8. Novocaine blockade of the stellate ganglion.
9. Electrophoresis with novocaine on the cervical sympathetic nodes, endonasal electrophoresis with aminazine, D'Arsonval currents on the affected limb.
10. X-ray therapy on the affected sympathetic ganglia.
11. Surgical treatment: preganglionic sympathectomy.
Treatment of erythromelalgia.
Effect on parasympathetic tone:
Anticholinergics (belladonna preparations, atropine).
Ganglioblockers.
Antihistamines.
Drugs that improve microcirculation: trental, cavinton.
Agents that strengthen the vascular wall (ascorbic acid, 5.
rutin, calcium supplements).
Novocaine blockade of the lumbar ganglia.
Cool foot baths.
Electrophoresis with calcium on the lumbar sympathetic nodes, currents 8.
DArsonval on the affected limb, general electrophoresis with calcium according to Vermeule.
During an attack, cold is applied locally, administered subcutaneously 9.
atropine.
Features of the treatment of hypothalamic disorders.
Etiotropic therapy is carried out depending on the genesis 1.
hypothalamic syndrome.
Pathogenetic therapy is prescribed depending on the nature of 2.
vegetative disorders.
The presence of neuroendocrine metabolic disorders often requires 3.
carrying out hormone replacement therapy together with an endocrinologist.
Symptomatic therapy.
Psychotherapy.
INNERVATION OF THE BLADDER AND DISORDERS
URINATION
In the neurological clinic, dysfunction of the pelvic organs (disorders of urination, defecation and genital organs) are quite common.Urination is carried out by the coordinated activity of two muscle groups: m. detrusor urinae and m. sphincter urinae. Contraction of the muscle fibers of the first group leads to compression of the wall of the bladder, squeezing out its contents, which becomes possible with simultaneous relaxation of the second muscle. This happens as a result of the interaction of the somatic and autonomic nervous systems.
The muscles that make up the internal sphincter of the bladder and m. detrusor vesicae, consist of smooth muscle fibers that receive autonomic innervation. The external urethral sphincter is formed by striated muscle fibers and innervated by somatic nerves.
Other striated muscles also take part in the act of voluntary urination, in particular the muscles of the anterior abdominal wall and the diaphragm of the pelvic floor. The muscles of the abdominal wall and diaphragm, when tense, cause a sharp increase in intra-abdominal pressure, which complements the function of m. detrusor vesicae.
The mechanism for regulating the activity of individual muscle formations that ensure the function of urination is quite complex. On the one hand, at the level of the segmental apparatus of the spinal cord there is autonomic innervation of the smooth fibers of these muscles; on the other hand, in an adult, the segmental apparatus is subordinate to the cerebral cortical zone and this carries out the voluntary component of the regulation of urination.
In the act of urination, two components can be distinguished:
involuntary reflex and voluntary.
The segmental reflex arc consists of the following neurons (see Fig.): afferent part - cells of the intervertebral node SI-SIII, dendrites end in the proprioceptors of the bladder wall, are part of the pelvic splanchnic nerves (nn. splanchnici pelvini), pelvic nerve - nn. pelvici, the axons go in the dorsal roots and spinal cord, contacting the cells of the anterolateral part of the gray matter of the spinal cord segments SI-SIII (spinal center of parasympathetic innervation of the bladder).
The fibers of these neurons, together with the anterior roots, exit the spinal canal and, as part of the pelvic nerve (n. pelvicus), reach the wall of the bladder, where they are interrupted in the cells pl. vesicalis.
The postsynaptic fibers of these intramural parasympathetic nodes innervate the smooth muscles of n. detrusor vesicae and partially internal sphincter. Impulses along this reflex arc lead to a contraction of m. detrusor vesicae and relaxation of the internal sphincter.
Schematically, the innervation of the bladder can be depicted as follows (see Fig. 1).
Rice. 1. Innervation of the bladder and its sphincters:
1 - pyramidal cell of the paracentral lobule cortex; 2 - cell of the nucleus of the thin bundle; 3 - sympathetic cell of the lateral horn LI-II; 4 - cell of the spinal node; 5 - parasympathetic cell of the lateral horn SI-III, 6 - peripheral motor neuron; 7 - genital nerve; 8 - cystic plexus; 9 - external sphincter of the bladder; 10-internal sphincter of the bladder; 11 - hypogastric nerve; 12 - bladder detrusor; 13 - inferior mesenteric node; 14 - sympathetic trunk; 15 - cell of the visual thalamus; 16 - sensitive cell of the paracentral lobule. Sympathetic cells that innervate the bladder are located at the level of LI-II segments of the spinal cord. The fibers of these sympathetic neurons, together with the anterior roots, leave the spinal canal, then separate in the form of a white connecting branch and pass, without interruption, through the lumbar nodes of the sympathetic trunk, as part of the mesenteric nerves they reach the inferior mesenteric ganglion, where they switch to the next neuron. Postsynaptic fibers consisting of n. hypogastricus approach the smooth muscles of the bladder.
Automatic emptying of the bladder is ensured by two segmental reflex arcs (parasympathetic and somatic). Irritation from stretching its walls is transmitted along the afferent fibers of the pelvic nerve to the spinal cord to the parasympathetic cells of the sacral segments of the spinal cord; impulses along the efferent fibers lead to contraction of the m.detrusor vesicae and relaxation of the internal sphincter. The opening of the internal sphincter and the flow of urine into the initial parts of the urethra trigger another reflex arc for the external (striated) sphincter, upon relaxation of which urine is released. This is how the bladder functions in newborns. Subsequently, in connection with the maturation of the suprasegmental apparatus, conditioned reflexes are also developed, and a feeling of the urge to urinate is formed. Typically, such a urge appears when intravesical pressure increases by 5 mmHg. Art. The voluntary component of the act of urination includes control of the external urethral sphincter and auxiliary muscles (abdominal muscles, diaphragm, pelvic diaphragm, etc.).
Sensitive neurons are located in the intervertebral ganglia SI-SIII.
Dendrites pass as part of the pudendal nerve and end with receptors both in the wall of the bladder and in the sphincters. The axons, together with the dorsal roots, reach the spinal cord and, as part of the dorsal funiculi, rise to the medulla oblongata. These paths then go to the gyrus fornicatus (sensory area for urination). Through associative fibers, impulses from this zone are transmitted to central motor neurons located in the paracentral lobe cortex (the motor zone of the bladder is located near the foot area). The axons of these cells as part of the pyramidal tract reach the cells of the anterior horns of the sacral segments (SII-SIV). Fibers of peripheral motor neurons, together with the anterior roots, leave the spinal canal, form the genital plexus in the pelvic cavity and as part of the n. pudendus; approach the external sphincter. When this sphincter contracts, it is possible to voluntarily retain urine in the bladder.
With a bilateral disruption of the connections of the cerebral (cortical) zones of the bladder with its spinal centers (this happens with transverse damage to the spinal cord at the level of the thoracic and cervical segments), a dysfunction of urination occurs. Such a patient does not feel the urge or the passage of urine (or a catheter) through the urethra and cannot voluntarily control urination. In case of an acute disorder, urinary retention (retentio urinae) first occurs; the bladder fills with urine and stretches to a large size (its bottom can reach the navel and above);
it can only be emptied using a catheter. Subsequently, due to an increase in the reflex excitability of the segmental apparatus of the spinal cord, urinary retention is replaced by periodic incontinence (incontinentio intermittens).
In milder cases, an imperative urge to urinate is observed.
When the segmental autonomic innervation of the bladder and sphincters is disrupted, various urination disorders occur.
Urinary retention occurs when the parasympathetic innervation of m. detrusor vesicae bladder (spinal cord segments SI-SIV, n. pelvicus).
Denervation of the internal and external sphincters leads to true urinary incontinence (incontinentia vera). This occurs when the lumbar segments of the spinal cord and the roots of the cauda equina are affected, n. hypogastricus and n. Pudendus. In such cases, the patient cannot hold urine; it is released involuntarily, either periodically or continuously.
There is another type of urination disorder:
paradoxical urinary incontinence (ischuria paradoxa), when there are elements of urinary retention (the bladder is constantly full, it does not empty voluntarily) and incontinence (urine constantly flows out drop by drop due to mechanical overstretching of the sphincter).
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5. ABE 55. A
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