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MINISTRY OF EDUCATION OF THE RUSSIAN FEDERATION
INSTITUTE FOR THE DEVELOPMENT OF VOCATIONAL EDUCATION G.A.ERMOLAEVA, R.A.KOLCHEVA
TECHNOLOGY AND EQUIPMENT FOR THE PRODUCTION OF BEER AND SOFT DRINKS
Textbook
Recommended by the Expert Council on Initial Vocational Education for Primary Vocational Education Institutions
ACADEMA
Moscow
2000
UDC (075.22) BBK 36.87-722 + 36.88-722 E 74
Federal Book Publishing Program of Russia
Reviewer Chief Specialist of the Ministry of Agriculture G. L. Sviridova
E 74
Ermolaeva G.A., Kolcheva R.A. Technology and equipment for the production of beer and soft drinks: Proc. for the beginning prof. education. -M.: IRPO; Ed. Center "Academy", 2000. - 416 p. ISBN 5-8222-0118-0 (IRPO) ISBN 5-7695-0631-8 (Academy Publishing Center)
The modern technology for the preparation of malt, beer, non-alcoholic and low alcohol drinks, kvass, mineral waters. The device and principle of operation of the technological equipment used, as well as methods of chemical-technological control of the quality of raw materials and finished products. The requirements for raw materials for the preparation of drinks, process water, containers and auxiliary materials, as well as for the stability 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 enterprises in the brewing and non-alcoholic industries of the food industry.
UDC (075.22) BBK 36.87ya722 + 36.88ya722
© 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, promotes better metabolism.
Brewing is one of the oldest industries. It is assumed that as early as 7 thousand years BC. Beer was brewed in Babylon barley malt and wheat. Then the method of making beer spread in ancient Egypt, Persia, among the peoples who inhabited the Caucasus and southern Europe, and later throughout Europe.
Beer in Russia. All Slavic languages have the word "beer". Previously, this word was called 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 passed on the practice of using hops to other European nations.
During archaeological excavations on the site of Ancient Novgorod, birch bark letters were found, in which perevary was mentioned. Perevary are intoxicating drinks made from honey and beer, which are distinguished by a high strength. How highly valued digests can be judged by the fact that honey and digests were a tribute in Russia. It should also be noted that beer, malt and hops were part of the dues of peasants for the use of land.
In Russia, beer and mead 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 used at feasts. They brewed beer in the 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 cancelled.
Over time, more and more breweries appear in Russia. In 1715, at the direction of Peter I, malt makers and brewers were sent to St. Petersburg, which contributed to the development of brewing. The foundation of the current brewery in Lviv dates back to the same year. Beer in Russia is becoming familiar and popular and even ends up 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 large St. Petersburg breweries. Kaluga beer, obtained by top fermentation, was especially famous then.
The history of Petersburg brewing is interesting. In 1795, with the highest approval of Catherine II, Abraham Friedrich Cro-
3
In St. Petersburg, an elder of Russian brewing was founded - a brewery, which bore the name of Alexander Nevsky. The plant produced up to 170,000 decaliters per year (1 decaliter or 1 dal equals 10 liters, and 1 hectoliter or I hl - 100 liters) of beer, which was delivered to the imperial table. At the end of the XVIII century. Piotr Ka-zalet founded a beer production near the Kalinkin bridge. The Kalinkinsky brewery specialized in the production of the best, elite varieties of beer. In 1S48, Kron and Cazalet merged their factories, and 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 society was established on Petrovsky Island, which became the supplier of the court of His Imperial Majesty. In 1872, the Vienna plant * of the Russian-Austrian joint-stock company was founded.
“A.I. Ermolaeva, G.A. Baranov. VEGETATIVE NERVOUS SYSTEM AND VEGETATIVE DISORDERS. Tutorial PENZA 2015 The tutorial describes the structure and functions of the autonomic nervous system, ...»
MINISTRY OF EDUCATION AND SCIENCE OF THE RUSSIAN FEDERATION
Federal state budget educational
institution of higher professional education
"Penza State University" (PGU)
A.I. Ermolaeva, G.A. Baranov.
AUTONOMIC SYSTEM
AND VEGETATIVE DISORDERS.
Tutorial
The textbook describes the structure and functions of the autonomic nervous system, clinical and paraclinical methods of their study, the main types of autonomic disorders.
The textbook is intended for students of 3-6 courses of medical universities, and can be used by neurologists, neurosurgeons and doctors of other specialties.
Compiled by:
head Department of Neurology and Neurosurgery of the Penza State Medical Institute, Doctor of Medical Sciences A.I. Ermolaeva, Ph.D. Associate Professor of the Department of Neurology and Neurosurgery G.A. Baranov.
Reviewers:
Doctor of Medical Sciences, Professor of the Department of Neurology of the Penza Institute for Postgraduate Medical Education 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-publishing commissions of the Medical Faculty of Penza State University.
1. Autonomic nervous system and autonomic disorders…………..4
2. Neurogenic dysfunctions of the pelvic organs….……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….
3. Tests ……………………………………………………………………….33
4. Answers to tests…………………………………………………………….38
5. Literature…………………………………………………………………..39
VEGETATIVE NERVOUS SYSTEM AND VEGETATIVE
VIOLATIONS
The structure and functions of the autonomic (autonomous) nervous system.Functional role of the VNS:
1. Regulates all internal processes of the body: the activity of internal organs, endocrine glands, blood and lymphatic vessels, maintaining the trophism of all body tissues:
2. Provides homeostasis of the body - the constancy of the internal environment and the stability of its basic physiological functions.
3. Provides energy support 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 a change in the activity of the body. This combination of functions ensures the adaptation of the internal environment of the body to constantly changing environmental conditions.
The structure of the autonomic nervous system.
Like the somatic nervous system, the autonomic nervous system is made up of neurons, the main 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 mediator adrenaline, the parasympathetic part - by acetylcholine.
The inhibitory effect on the sympathetic part is exerted by the mediator ergotamine; on the parasympathetic - atropine.
All organs are under the influence of both the sympathetic and parasympathetic parts of the ANS.
Parasympathetic innervation provides stable states of organs, and sympathetic 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 the neurons of the lateral horns of the spinal cord segments C8-L2. The axons of these cells (myelinated preganglionic fibers) exit the spinal cord as part of the anterior roots, then separate and end at the nodes of the border sympathetic trunk. The border sympathetic trunk lies on the lateral surface of the bodies of the cervical, thoracic, lumbar, sacral vertebrae and consists of 3 cervical, 12 thoracic, 5 lumbar, 4 sacral and one coccygeal ganglion. Postganglionic (unmyelinated) fibers go to the internal organs, form plexuses around blood vessels, and are part of the peripheral nerves. Part of the preganglionic fibers in the nodes of the border sympathetic trunk is not interrupted, but goes to intermediate nodes (prevertebral ganglia), which are located between the border sympathetic trunk and 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 small pelvis.
Each sympathetic node gives branches to the innervation of the spine, as well as to the spinal nerves and to innervate the internal organs.
Cervical sympathetic nodes innervate the pharynx, larynx, thyroid gland, give branches to the heart. From the nuclei of the ciliospinal center, located in the lateral horns of the C8-D1 segments, the 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 basin). The branches of this nerve, together with the ophthalmic artery, reach the ciliary node, which lies on the optic nerve, branches go from it to the following muscles: m.dilatator pupillae; m.tarsalis superior;
m.orbitalis. When the ciliospinal center, upper cervical node or these fibers are affected, Horner-Claude Bernard syndrome occurs, which includes a triad of symptoms - ptosis, miosis, enophthalmos.
From the third cervical sympathetic node (stellate) branches go to form the cardiac aortic plexus, the vertebral nerve, which forms the plexus of the vertebral artery and accompanies the entire vertebrobasilar basin. Also, from the third cervical sympathetic node, cutaneous vegetative innervation of the hand is carried out.
Thoracic sympathetic nodes:
the upper six - innervate the organs of the chest (heart, pericardium, trachea, lungs);
the lower six innervate the abdominal organs. Through the lower thoracic nodes pass the large and small celiac nerves, which form the solar plexus.
Lumbar sympathetic nodes give branches to the formation of the solar plexus (innervation of the kidneys, ureters), and also provide autonomic skin innervation of the leg.
The sacral sympathetic nodes innervate the pelvic organs. With the defeat of the coccygeal node, coccygodynia 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 exit 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 narrows the pupil.
Perlea's nucleus - fibers exit 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 - the fibers exit as part of the facial nerve in the cerebellopontine angle, exit the skull through the porus acusticus, then, as part of the large stony nerve, reach the pterygopalatine ganglion, reach the lacrimal gland, providing its secretion and expansion of the vessels of the gland.
Taste nucleus - (nucleus tractus solitarius - a nucleus common to VII and IX pairs of cranial nerves); fibers in the composition of the facial nerve, then in the composition of the tympanic string carry out taste innervation of the anterior 2/3 of the tongue; fibers in the glossopharyngeal nerve innervate the posterior third of the tongue.
salivary nucleus (is common to IX, VII pairs of cranial nerves); fibers from the upper portion of the nucleus go as part of the facial nerve, then the tympanic string and innervate the hyoid and submandibular gland. From the lower portion of the nucleus, fibers in the glossopharyngeal nerve reach the ear node and innervate the parotid gland.
Dorsal nucleus of the vagus nerve (located in the bottom of the rhomboid fossa); fibers go as part of the vagus nerve to all organs of the chest, then as part of the solar plexus they innervate the organs of the abdominal cavity.
The sacral region is represented by cells of the lateral horns at the level of SII-SIV segments.
The fibers go to the lower hypogastric plexus on the sides of the rectum, from this plexus the pelvic nerve emerges, which innervates the pelvic organs.
Suprasegmental (central) division of the autonomic nervous system (structure and functions).
Supra-segmental (higher) vegetative centers, which feature the absence 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 hypothalamic-limbic-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 - by the caudal edge of the mammillary bodies, the lateral - by the hypothalamus, 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 sections of the chiasm, the gray tubercle, the funnel of the gray tubercle, and the mastoid bodies.
Allocate:
the ergotropic system, which includes the posterior sections of the hypothalamic region, provides physical and mental activity through 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 a period of rest, a slow phase of sleep, mobilizes the vagoinsular apparatus (reduces blood pressure, slows the heart rate, narrows the bronchi, enhances intestinal motility).
The hypothalamus is the highest vegetative center, the place of coordination of the nervous, endocrine, 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 thalamus, and sensory organs.
Efferent pathways from the hypothalamus go to the optic tubercle, to the reticular formation of the brainstem, and the subcortical nuclei of the ER, to the parasympathetic nuclei of the brainstem. The hypothalamus is also closely related to 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;
the middle section - (includes sulfur tuberous nuclei), ensures the regulation of all types of metabolism;
posterior section - (includes 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 the 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 associated with the posterior 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 small cell nuclei of the ventral hypothalamic region are associated with the anterior pituitary gland, the adenohypophysis. They produce neurohormones (releasing factors) that 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, thyrotropic, somatotropic, luteinizing, follicle-stimulating hormones and 2 factors are inhibitory: one inhibits the release of prolactin, the other melanocytostimulin.
In addition, in the hypothalamus there are 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 has a large vascularization (1200 capillaries per 1 mm). Numerous vessels of the hypothalamic region are highly permeable to large molecular protein compounds, which contributes not only to high sensitivity, but also to the penetration of infectious agents, toxins, and hormones. This causes a high sensitivity of the hypothalamic region to various physiological and pathological influences.
All activity of the ANS is controlled and regulated by the cortical parts of the nervous system (mediobasal parts of the frontal temporal lobes, parietal lobes). The hypothalamus is closely related 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 transparent septum, the amygdala, and the anterior nuclei of the hypothalamus. The limbic system is of great importance in emotional reactions, the process of attention, memory, regulates sleep and wakefulness. Therefore, any impact on the structures of the hypothalamus or the 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, the reticular formation plays a significant role in the regulation of autonomic functions, 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 itself 1.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", having both signs of both Goldi's type I and II. These cells are located in different parts of the RF with different densities and differ in their sizes, which served as the basis for isolating a significant number (over 40) of nuclei in it.
3. The length of the RF stem along the length corresponds to the length of the stem from the caudal brain to the oral part of the midbrain.
4. Efferent connections of the reticular formation:
a) descending system - reticulospinal. It starts in the bridge and goes to the anterior and lateral columns of the spinal cord.
b) long ascending RF fibers are sent to the diencephalon and telencephalon, ending in the thalamus, 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 nucleus of the tegmentum pons.
5. Afferent connections of the reticular formation:
a) spino-reticular fibers passing in the spinal cord in the anterolateral columns. They end in the RF medulla oblongata and pons.
b) cortical-reticular fibers arise in various parts of the cerebral cortex. Among them, fibers that arise in the sensorimotor region of the cortex predominate. They end in those cell groups in which the reticulospinal and reticulo-cerebellar pathways originate.
c) cerebellar-reticular fibers originate in various nuclei of the cerebellum and end in different formations of the RF.
d) cellular elements of the RF 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 RF, semi-specialized formations are also distinguished, closely related to the RF, formed on the basis of its neurons and regularly carrying out blood circulation and respiration:
a) vasomotor center. Inside it, depressor and pressor centers are distinguished. Depressor center, the effect of irritation of which is reduced to a decrease 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 directly projecting to the spinal cord.
The pressor center is located rostral to the depressor center. It also allocates 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 somatovegetative interaction during wakefulness and sleep) is only a part of more global integrative systems, including limbic and non-cortical structures, in interaction with which the organization of expedient 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 mammillan.
2. The main nuclei of the hypothalamic region are as follows:
a) supraoptic nucleus
b) three groups of nuclei of the gray hillock,
c) mamillo-infundibular nucleus,
d) pallido-infudibular nucleus lying in the middle part of the gray tubercle.
e) introductory nucleus, lying between the legs of the fornix.
e) paraventricular nucleus.
g) connecting the nucleus, which lies in the middle commissure (third ventricle).
h) paramedian core.
i) the nucleus of the mammillary body.
3. The rest of the mass of the hypothalamic region consists of scattered elements, smaller than in the nuclei of the gray matter cells, 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) the fibers of the terminal cavity enter the hypothalamus, through which communication is carried out with the ammon horn, piriform lobes and tonsils.
c) encircles the visual afferent system, the fibers of which follow from the optic nerves and chiasm to the hypothalamus.
d) a bundle of fibers from the globus pallidus to the hypothalamus.
e) fibers of the fornix enter the hypothalamus, arising in the hippocampus and ending in the mammillary bodies.
f) The experiment describes the connections of the hypothalamus with the midbrain. The fibers of this system originate in the anterior RF of the midbrain and end in almost all parts of the hypothalamus.
g) in addition, fibers from the spinal cord, interrupted in the nuclei of the columns of the medulla oblongata, come to the hypothalamus.
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 (hypothalamic-pituitary tract),
b) the Vic D'Azira bundle connects the mammillary bodies with the anterior nucleus of the thalamus,
c) long descending systems of the hypothalamus connect the hypothalamus with the reticular formation of the trunk,
d) diffuse ascending systems connect the posterior hypothalamus with the basal-frontal and olfactory structures of the cerebral cortex,
e) connections of the mammillary bodies with the cerebellum.
6. Inside the hypothalamus, specific nuclei and non-specific structures are isolated.
7. Among the specific ones are formations projecting onto the pituitary gland, the effect of irritation and destruction of which is strictly specific, and the distinguishing 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 pituitary gland. In other specific nuclei, releasing (releasing) factors that enter the adenohypophysis 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-, temoreceptors) cannot be considered specific. The responses obtained when they are irritated depend primarily on the parameters of the irritated agent. On the one hand, they enter the limbic system, on the other hand, they are a continuation of the reticular formation of the brain stem, in fact, its most oral section.
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, in the hypothalamus (with the exception of its specific departments) not individual functions are presented, but coordination synergies.
The hypothalamic region is one of the links of integration systems, a relatively specific feature of which is neurohumoral coordination, analysis of humoral changes, the inclusion of the hormonal system in the organization of adaptive behavior.
11. The hypothalamus regulates metabolism, thermoregulation, is related to the organization of sleep and wakefulness, 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 thalamus.
6. Amygdala complex (almond-shaped body and fence).
7. Piriform gyrus.
8. Olfactory tubercles.
9. Olfactory tracts.
Connections of the limbic system:
Afferent - impulsation follows in the LS mainly from the reticular formation of the trunk, hypothalamus, thalamus and from various parts of the cortex.
Efferent connections - with the cortex (all its departments), with subcortical formations, the visual tuberosity, the hypothalamus and the reticular formation of the trunk.
Neural circles within the limbic system:
Great circle of Peipitz - hippocais - fornix - cores of transparent 1.
septa - mammillary bodies - anterior nucleus of the thalamus - cingulate gyrus.
Small circle of Peipitz - amygdala complex - hypothalamus.
Segmental circle of Nauta - septum - supracallus 3.
plates - hippocampus - vault - 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. Organization of 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 can be observed - lack of fear, aggressiveness, complacency, pronounced hypersexuality, increased oral exploratory automatisms.
Violation of motivation - a disorder of complex behavioral acts 3.
(anatomical-ambulistic syndromes, lack of initiative).
Memory disorders - difficulty in reproducing traces, 4.
difficulty remembering, there may be manifestations of Korsakoff's syndrome.
Psychomotor epileptic seizures are characteristic 5.
psychosensory, visceral and other sensory auras.
Syndrome of akinetic mutism ("awake coma") - absence 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 you need to keep in mind the following:
1. In Russia, the biological theory of emotions by P.K. Anokhin.
2. This theory was created by P.K. Anokhin on the basis of his own original general physiological theory of functional systems.
The functional system, according to Anokhin, is a branched, self-regulating central-peripheral organization that provides, on the basis of constant reverse afferentation, one or another adaptive result 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 needs of the organism and the probability of its satisfaction at the moment.
5. Human emotions always carry certain adaptive effects (adaptation to an external situation or internal motives).
6. At the time of the emergence of any need, a person first has a negative emotion (since at the time of the emergence of a need, it has not yet been satisfied).
7. An appropriate mechanism arises in the body that provides the necessary reaction to meet the needs.
8. If the need or desire is satisfied, the emotion is positive.
9. Some of the emotions and motivations are genotypically laid down as a certain form of response. These forms 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) a multisensory type of convergence on neurons, b) a multibiological type - the perception of complex biological functions (hunger, pain, orientation, etc.), c) a sensory biological type - a combination of receptor and biological neurons on the same neurons stimuli, d) axonal-sensor-biological type - a combination of previous and efferent neurons.
All this happens at the level of cortical-subcortical structures related to the system of afferent synthesis.
12. For the implementation of emotions, complex types of synthesis are included. After the decision is made, a model of action is developed that determines the behavior of a person.
13. After the implementation of the action, there is a reverse afferentation to the acceptor of the action, a comparison of the program and the result, 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 match, a negative emotion arises, a new program is adopted - a new action, etc. until a coincidence (positive emotion) occurs.
15. At present, the prevailing opinion is that there is no severe localization of emotional centers. It is believed that the corresponding functional systems, which can change in the course of individual life, are created and mutually overlap in accordance with the specific situation and living conditions of the individual. Human emotions are understood as the experience of attitude to the surrounding reality and internal state.
16. A person has two main mechanisms for shaping emotions: a) internal experience (sphere of mood), b) external expression of emotions - facial expressions, gestures, the play of vasomotors.
Emotion is very closely related to motivations (drive and attraction)
1. Motivation characterizes those actions that are caused by the internal needs of a person.
2. There are a number of specialized cells in the hypothalamus that are capable of subtly capturing changes in the parameters of the internal environment. Here there is a transformation of chemical irritation (arising in response to a change in parameters) into a nerve impulse.
3. The distribution of impulses from the cells of the hypothalamus to the reticular formation, the limbic system and the cortex leads to the organization of a peculiar behavior of humans and animals, aimed at searching in the external environment for the appropriate 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 performed action leads to a certain emotional state, depending on the degree of satisfaction.
5. After comparison in the action acceptor, if the program and the action coincide, the emotional consolidation of motivation occurs and this is fixed 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 even more high level motivations (a purely human type) associated with the social factor (patriotism, heroism, etc.).
7. In the 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. Attraction arises a lot, but at each stage the most important functional system is selected - the dominant one (more often either hereditarily programmed or fixed on the basis of individual experience), c) reinforcement - the external stimulus that the body is looking for (to implement changes in the latter).
Clinical methods of examination of the autonomic nervous system.
The complex of studies of the autonomic nervous system includes two groups of methods: the first allows assessing the state of the suprasegmental section, the second allows assessing the state of the segmental section. The study of the suprasegmental department includes the determination of autonomic tone, reactivity and provision of activity. The state of the segmental department is assessed by the level of functioning of the internal organs and physiological systems of the body. This determines which part of the autonomic nervous system (sympathetic or parasympathetic) suffers and which parts (afferent or efferent) are affected.
The study of the vegetative status consists of three groups of indicators:
1. Study of the initial autonomic tone.
Vegetative tone is the degree of tension (basal level of activity) in the functioning of an organ (heart, lungs, etc.) or physiological system (cardiovascular, respiratory, etc.) in a state of relative rest. It is determined by the impulse coming to the organ from postganglionic sympathetic and parasympathetic fibers. The vegetative tone is influenced by segmental and suprasegmental vegetative centers. The influence of segmental vegetative centers determines the tone within the system, and suprasegmental - in the body as a whole. To determine the autonomic tone of the body, you need to assess the tone in each of its systems.
Methods for studying autonomic tone include special questionnaires, tables and data from an objective study. In the process of targeted questioning of patients, attention is drawn to the 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, such signs as the size of the pupils and the palpebral fissure, skin color and temperature, body weight, arterial systolic and diastolic pressure, and pulse rate are recorded.
Conduct a study of the function of the thyroid gland, adrenal glands, blood glucose levels using stress tests.
ECG indicators are evaluated.
Signs of the predominance of the activity of the sympathetic department are: tachycardia, increased blood pressure, mydriasis, pallor and dryness of the skin, pink or white dermographism, weight loss, recurrent chill-like hyperkinesis, superficial anxious sleep, an increase in the content of catecholamines and ketosteroids, an increase in pulse rate, detection of ECG shortening of the RR, PQ intervals, an increase in the R wave and flattening of the T wave.
The predominance of the tone of the parasympathetic division 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, a decrease in blood glucose levels, and a relative decrease in thyroid function. The ECG reveals sinus bradycardia, an increase in RR, P-Q intervals, an expansion 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 ratio of 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 responses indicators of reaction Skin color Paleness Tendency to hyperemia Vascular pattern Not pronounced Increased, cyanosis Grease Normal Increased Dryness Increased Normal Skin temperature Decreased Increased Pigmentation Increased Decreased Body temperature Increased Decreased Cold tolerance Satisfactory Poor Heat tolerance Poor, heat intolerance Satisfactory Body weight Tendency to lose weight Tendency to increase Appetite Increased Decreased Pupils Dilated Normal palpebral fissures Dilated Normal Pulse Labile tachycardia normal diastolic) ECG Sinus tachycardia Sinus bradycardia Dizziness Uncharacteristically Often Respiratory rate Normal or rapid Slow, deep salivation Decreased Increased Young Thick Liquid Gastric acidity Normal or decreased Increased juice Intestinal motility Atonic constipation, mild Dyskinesia, spastic peristalsis Constipation, diarrhea Urination Polyuria, light urine Urgent urge Pilomotor reflex Enhanced Normal Allergic reactions Absent Tendency (edema, itching) Temperament Increased excitability Lethargy, immobility Sleep Short, poor Sleepiness Physical Increased Decreased performance Mental sphere Absent-mindedness, inability to focus on something satisfactory, one thing, activity is higher in the evening activity is higher in the first half of the day The number of erythrocytes Increased Decreased The number of leukocytes Increased Decreased Level of glucose in the blood Increased, normal Decreased (hypoglycemia ) Hunger tolerance Normal Poor UV response Normal, reduced Increased Orthostatic test Pulse relatively accelerated Pulse relatively slow Clinostatic test Pulse relatively slow Pulse s relatively accelerated Ashner test Normal, paradoxical acceleration Significant slowing of the pulse rate
2. Study of autonomic reactivity.
Vegetative 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 activity.
The following samples are most often used in clinical practice:
The oculocardial reflex (Dagnini-Ashner) produces pressure on the eyeballs, as a result of which, in healthy individuals, heart contractions slow 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 rate by 2-4 per minute indicates an increase in the excitability of the sympathetic part.
Solar reflex - for a patient lying on his back, the examiner produces 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 oculocardial reflex.
Cold test - in the position of the patient lying down, the heart rate is counted and blood pressure is measured. After that, the brush of the other hand is lowered for 1 minute in cold water temperature 4 °, then remove the hand from the water and record blood pressure and pulse rate every minute until returning to the initial level. Normally, this happens after 2-3 minutes. With an increase in blood pressure by more than 20 mm Hg. the reaction is assessed as pronounced sympathetic, less than 10 mm Hg. as moderate sympathetic, and with a decrease in pressure - as parasympathetic.
Orthoclinostatic reflex - the study is carried out in two steps.
In a patient lying on his back, the number of heart contractions is counted, and then they are asked to stand up quickly (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 mm Hg. When the patient moves to a horizontal position, the 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 slowing of the pulse during the clinostatic test indicates an increase in the excitability of the parasympathetic part.
Pilomotor reflex - the "goosebumps" reflex is caused by a pinch or by applying a cold object (a test tube with cold water) or a coolant (a cotton wool moistened with ether) to the skin of the shoulder girdle or the back of the head. On the same half of the chest, "goosebumps" appear as a result of contraction of smooth hair muscles. The arc of the reflex 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. There is diffuse sweating. With damage to the hypothalamic region, its asymmetry can be observed. With damage to the lateral horns or anterior roots of the spinal cord, sweating is disturbed in the zone of innervation of the affected segments. With damage to the diameter of the spinal cord, the intake of acetylsalicylic acid causes sweating only above the site of the lesion.
A test with pilocarpine - the patient is injected subcutaneously with 1 ml of a 1% solution of pilocarpine hydrochloride. As a result of irritation of the postganglionic fibers going to the sweat glands, sweating increases. It should be borne in mind that pilocarpine excites peripheral Mholinoreceptors, which cause an increase in the secretion of the digestive and bronchial glands, constriction of the pupils, an increase in the tone of the smooth muscles of the bronchi, intestines, bile and Bladder, uterus.
However, pilocarpine has the strongest effect on perspiration. With damage to the lateral horns of the spinal cord or its anterior roots in the corresponding area of the skin, after taking acetylsalicylic acid, sweating does not occur, and the introduction of pilocarpine causes sweating, since the postganglionic fibers that respond to this drug remain intact.
Light bath - warming the patient causes sweating. The reflex is spinal, similar to the pilomotor. The defeat of the sympathetic trunk completely excludes sweating on pilocarpine, acetylsalicylic acid and warming the body.
3. Vegetative provision of activity is carried out using modeling of various activities:
Physical - dosed physical activity, bicycle ergometry, dosed walking, dosed squatting;
Mental - counting in the mind;
Emotional - modeling negative or positive emotions.
Assessment of vegetative reactions is carried out by changing the pulse, respiration, blood pressure, ECG, 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, thyroid gland, ovarian function, and study the level of tropic hormones of the pituitary gland.
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Syndromes of lesions of the segmental division of the ANS.
With the defeat of the segmental department of the ANS, sympathalgia often occurs, which is characterized by:
1) pain burning, cutting, pressing;
2) is related to temperature, increases from heat and decreases from cooling;
3) paroxysmal, aggravated by weather changes, emotional stress;
4) the localization of pain does not correspond to the zones of innervation of the peripheral nerves;
5) is combined with a change in pain sensitivity of a vegetative nature: hyperalgesia, hypalgesia with hyperpathy, fuzzy boundaries of sensitivity disorders;
6) soreness of the vessels on palpation;
7) the presence of vasomotor disorders: hyperemia of the skin, pallor, pastosity.
The whole complex of vegetative manifestations that occur when the segmental (peripheral) division of the ANS is affected is called peripheral autonomic insufficiency (PVN).
Primary peripheral autonomic failure is a chronic, slowly progressive disease. They are based on the degeneration of segmental vegetative apparatuses, 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 syndrome, Riley-Day, Bradbury-Eggleston. The main symptom is the 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.
Manifested in the form of the following clinical forms:
1. Damage to the lateral horns of the spinal cord (vegetative disorders are combined with damage to other structures);
2. The defeat of the sympathetic nodes of gangliopathy, reflex sympathetic dystrophy;
3. Defeat of 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, angioedema, angioedema;
5. The defeat of the autonomic plexus: autonomic plexopathies;
6. The defeat of the segmental department with the involvement of the suprasegmental departments: causalgia, phantom pain, reflex paralysis, contractures, hyperkinesis, reflex sympathetic dystrophy.
Clinical characteristics of the main forms of damage
1. The defeat of the lateral horns of the spinal cord can be with syringomyelia, vertebrogenic myelopathy, tumors of the spinal cord, inflammatory lesions of the spinal cord. Manifested by vascular, trophic, sensory, secretory, visceral disorders according to the level of damage, combined with signs of damage to the sensory, motor pathways.
2. The defeat of the sympathetic nodes occurs with inflammatory adhesions in the chest and abdominal cavities, traumatic injuries, infectious diseases.
According to the level of innervation, patients experience skin symptoms in the form of vascular disorders (redness or pallor of the skin, cooling, warming), pilomotor disorders, atrophy of the skin and subcutaneous tissue, impaired sweating.
There are visceral disorders: damage to the abdominal organs, small pelvis, pain in the heart area without changes in the ECG (not removed by coronary ointment), pain in the pelvic area, muscle symptoms in the form of atrophy and hypotension of the muscles, pain (sympathalgia) of a vegetative nature, sensitivity disorders . Characterized by mental disorders in the form of melancholy, anxiety, fear. When the cervical sympathetic nodes are affected, Horner's syndrome or Petit's syndrome occurs.
3. The defeat of the autonomic plexus.
More often there is a lesion of the solar plexus - solaropathy.
Etiology: chronic traumatization of the plexus during enteroptosis, external mechanical trauma, aortic dilation, neoplasms, infections (malaria, syphilis, influenza, typhoid), inflammatory diseases of internal organs (cholecystitis, duodenitis, peptic ulcer stomach and duodenum), intoxication (alcohol, diabetic, lead), helminthic invasions.
Clinic: pain not associated with eating, in the epigastric region with irradiation to the chest, shingles, accompanied by fear of death, anxiety. Outside the attack, there is depression, a hypochondriacal state. The pain can be constant and in the form of crises, accompanied by an increase or decrease in blood pressure, constipation or diarrhea, vomiting. Similar symptoms may occur when other plexuses are affected.
4. Defeat of postganglionic vegetative fibers.
Occurs with damage to peripheral nerves containing a large number of autonomic fibers (these are sciatic, tibial, median, trigeminal nerves). If vegetative symptoms come to the fore, then the vegetative form of neuritis is diagnosed. So, for example, with neuritis of the sciatic nerve, there is a burning pain in the innervation zone with symptoms of hyperpathy, an increase or decrease in skin temperature, blanching 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 extremities and pain, vascular, trophic disorders predominate, then autonomic polyneuropathy is diagnosed. The cause may be more than 100 etiological factors, more common in alcoholic, diabetic polyneuropathy.
With the defeat of the vascular plexus of individual arteries, perivascular plexopathy occurs. For example, vertebral artery syndrome in cervical osteochondrosis.
5. Damage to the segmental division of the ANS with impaired vascular innervation.
Angiotrophoneurosis is a group of diseases arising from 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: collagenoses, especially scleroderma, lesions of the cervical spine, systemic vascular diseases, vibration disease, ergot intoxication.
The disease is manifested by 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) blanching of the fingers (lasts 5-20 minutes) - a spasm of capillaries occurs, paresthesias, burning are characteristic.
2) blue fingers (lasts up to 1 hour) - there is a spasm of arterioles, expansion of capillaries.
3) redness of the fingers - atony of arterioles and capillaries occurs.
First, the arms are affected, then the area of the nasolabial triangle, the legs.
Differential diagnosis between the disease and Raynaud's syndrome:
Disease Syndrome
1. The appearance of symptoms under the influence of 1. The spontaneity of the occurrence.
hypothermia, psycho-emotional arousal.
2. Symmetry of the lesion. 2. Asymmetry of the lesion.
3. Relatively favorable course by 3. Early onset of complications.
for several years, prolonged absence of gangrene.
Erythromelalgia.
Weir-Mitchell disease. It can occur as a syndrome after malaria, trauma, frostbite, multiple sclerosis, myxedema, mercury poisoning. It usually develops over the age of 40.
In pathogenesis, the irritation of the parasympathetic part of the ANS is important. It is clinically characterized by the occurrence of paroxysmal pain in the evening and at night in the feet, especially in 1 finger, swelling in the distal legs, a feeling of heat, reddening of the skin, dilated veins, increased pulsation of the arteries, and an increase in skin temperature in the edema area by 2-4 °. In the future, trophic disorders appear in the form of vesicles, pustules, the process spreads to the hands, nose, ears. Pain sensations sharply increase when the limb is warmed, standing, walking, and, conversely, significantly decrease in the cold, in the prone position. The attack lasts from several minutes to several hours.
Erythrosis - reddening of the distal limbs with mild trophic disorders, without pain.
Quincke's edema - occurs as a reaction to external specific stimuli, allergens. Characterized by persistent paralytic changes in the vessels, accompanied by an increase in vascular permeability.
Swelling of tissues, subcutaneous tissue develops on a small surface, most often it is the pharynx, larynx, face.
6. The defeat of 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, posterior horns, then, as part of superficial, deep sensitivity bundles, reach the thalamus and parietal region.
Therefore, in causalgia there is a peripheral focus of irritation in the nerve and a focus of irritation at the level of the thalamus. Causalgia occurs two weeks after injury and can last up to 14 years.
Clinic:
1. Intense burning pains with localization in the skin, painful sensations of dry skin (the “wet rag” symptom is typical).
2. Mismatch of localization of pain to the zone of innervation of the affected nerve.
3. Reducing pain on cooling and increasing on warming.
4. The presence of vasomotor, secretory, trophic disorders in the affected area.
When the process is generalized, the following symptoms are characteristic:
1. Increased pain with loud sounds, excitement, light stimuli;
2. Change in the behavior and psyche of the patient;
3. Formation of pain contractures;
4. Senestalgia - the spread of pain to secondary causal fields (for example: the spread of pain from the left hand to the right hand).
Phantom pain is intense, varied sensations in an amputated limb.
Syndromes of damage to the central part of the ANS Hypothalamic syndromes occur as a result of impaired production of releasing factors and neurotransmitter metabolism.
Etiological factors of damage to the hypothalamus:
infections (flu, rheumatism, tonsillogenic intoxication);
1) allergic factors;
2) traumatic brain injury;
3) intoxication - medicinal, industrial;
4) inflammatory diseases of internal organs by type 5) repercussion;
psychogenic (due to connections with the limbic system);
6) vascular diseases of the brain (hypertensive 7) disease, atherosclerosis, vasculitis).
Often it is not possible to identify brain damage, in which case there is a constitutionally determined biochemical defect in hypothalamic regulation, which can decompensate at various critical periods: puberty, pregnancy, menopause.
Also, the formation of the brain is influenced by the presence of diseases in parents, the nature of childbirth, the degree of full-term, occupational hazards.
Hypothalamic syndromes are a combination of autonomic, endocrine, trophic disorders caused by damage to the hypothalamus. Mandatory for the diagnosis of hypothalamic syndrome is the presence of neuroendocrine disorders.
Clinical classification of hypothalamic syndromes.
1. Neuro-endocrine-metabolic syndrome: diabetes insipidus, hypothalamic obesity, Itsenko-Cushing's disease, Babinsky-Frelich syndrome, acromegaly, persistent galactorrhea-amenorrhea syndrome, Morgagni-Stuart-Morel syndrome.
2. Violation of thermoregulation: hyperthermia (permanent, paroxysmal), hypothermia, chill-like hyperkinesis, "chill" syndrome.
3. Neuromuscular syndrome myasthenic;
myopathic;
myatonic;
myoplegic.
4. Neurotrophic syndrome, including malignant exophthalmos, changes in hair growth, osteoporosis, atrophy, ulcers of the gastrointestinal tract.
5. Violation of sleep and wakefulness: hypersomnia, narcolepsy, Pickwick's syndrome, periodic hibernation syndrome, hypothalamic insomnia.
6. Psychopathological syndrome: depressive, hypochondriacal, neurasthenic.
7. The vegetative-vascular-visceral syndrome is characterized by the occurrence of crises (sympathetic-adrenal, vagoinsular, mixed vegetative-visceral).
8. Hypothalamic epilepsy: characterized by stereotypical structure of the vegetative-vascular-visceral crisis, disorder of consciousness of varying degrees, tonic convulsions.
General principles of therapy for lesions of the segmental division of the ANS Etiotropic therapy is indicated if the autonomic syndrome develops against the background of an acute period of any disease. For instance, acute period 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 department of the ANS.
In the presence of symptoms of irritation of sympathetic formations, it is advisable to prescribe:
To reduce sympathoadrenal activity, central sympatholytics (reserpine 0.1 3 times a day),
Antipsychotics (chlorpromazine 0.025 1 time per day, sonapax, dopegyt 0.25 3 times a day), adrenergic blockers (phentolamine, pyrroxan, dihydroergotamine, nicergoline), adrenergic blockers (anaprilin, visken).
2) Ganglion blockers: benzohexonium, pentamine (in order to avoid orthostatic complications, they are used in small doses, per os).
3) Vasodilators (antispasmodics papaverine, nicotinic acid, no-shpa);
4) Tranquilizers: relanium, phenazepam, elenium, mezapam;
5) Sedatives: bromine, motherwort, valerian root;
6) With severe sympathalgia, finlepsin, tegretol are used;
7) For causalgia, neuroleptics, analgesics, carbamazepine drugs are prescribed, but not drugs!;
8) Mixed action drugs - belloid, bellaspon, bellataminal;
9) Means of general impact: mild maritime climate, carbonic, 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 Raynaud's disease, UVR, DDT, electrophoresis with calcium, novocaine, hydrocortisone phonophoresis, mud applications of not high temperature (37 °), electrophoresis with novocaine on the epigastric region with solaropathy);
11) IRT (braking 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 for sympathetic nodes in Raynaud's disease.
To reduce parasympathetic tone:
monoamine oxidase inhibitors (ephedrine);
tranquilizers;
Cholinolytics (cyclodol, tropacin, belladonna preparations);
Antihistamines (diphenhydramine, tavegil, betaserk, pipolfen);
low-calorie diet;
Coniferous baths;
IRT (exciting method).
With insufficient sympathetic tone:
Adrenomimetics: adrenaline, ephedrine.
Drugs that stimulate the nervous system: caffeine, phenamine, 2.
calcium preparations, ascorbic acid, glutamic acid, ginseng extract, Chinese magnolia vine.
A diet high in protein.
Mountain climate, cool showers, salt and radon baths.
Symptomatic therapy: analgesics, tranquilizers.
Psychotherapy.
Raynaud's disease treatment.
Vasoactive antispasmodics (no-shpa, complamin, nicotinic acid).
Antipsychotics (chlorpromazine).
Ganglioblockers (novocaine 0.5% intravenously).
Sympatholytics, -blockers (phentolamine, tropafen, reserpine, 4.
dopegit, sermion); blockers are not used, as they cause spasm of peripheral vessels).
ACE inhibitors (captopril, enalapril).
Means that improve the rheological properties of blood (trental, chimes, 6.
verapamil, corinfar, cordafen).
7. To normalize the synthesis of prostaglandins and reduce erythrocyte aggregation, NSAIDs (metindol, piroxicam) are used.
8. Novocaine blockade of the stellate node.
9. Electrophoresis with novocaine on the cervical sympathetic nodes, endonasal electrophoresis with chlorpromazine, D'Arsonval currents on the affected limb.
10. X-ray therapy for affected sympathetic ganglia.
11. Surgical treatment of preganglionic sympathectomy.
Treatment of erythromelalgia.
Impact on parasympathetic tone:
Cholinolytics (belladonna preparations, atropine).
Ganglioblockers.
Antihistamines.
Preparations that improve microcirculation: trental, cavinton.
Means that strengthen the vascular wall (ascorbic acid, 5.
rutin, calcium preparations).
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 Vermel.
During an attack, local cold is applied, subcutaneous injection 9.
atropine.
Features of therapy 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.
conducting hormone replacement therapy in conjunction with an endocrinologist.
Symptomatic therapy.
Psychotherapy.
BLADDER INNERVATION AND DISORDERS
URINATION
In the neurological clinic, dysfunctions 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. The contraction of the muscle fibers of the first group leads to compression of the bladder wall, to the extrusion of its contents, which becomes possible while relaxing 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 is 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, the diaphragm of the pelvic floor. The muscles of the abdominal wall and diaphragm, when tensed, cause a sharp increase in intra-abdominal pressure, which complements the function of m. detrusor vesicae.
The mechanism of regulation of the activity of individual muscle formations that provide 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 is the voluntary component of the regulation of urination.
There are two components to the act of urination:
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 proprioreceptors of the bladder wall, are part of the pelvic splanchnic nerves (nn. splanchnici pelvini), pelvic nerve - nn. pelvici, axons go in the posterior roots and spinal cord, contact with 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 bladder wall, where they are interrupted in the cells of pl. vesicalis.
The postsynaptic fibers of these intramural parasympathetic nodes innervate smooth muscles 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 cortex of the paracentral lobule; 2 - cell of the nucleus of a 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 - lower mesenteric node; 14 - sympathetic trunk; 15 - cell of the thalamus; 16 - sensitive cell of the paracentral lobule Sympathetic cells that innervate the bladder are located at the level of the 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, reach the inferior mesenteric node, where they switch to the next neuron. Postsynaptic fibers in n. hypogastricus approach the smooth muscles of the bladder.
Automatic emptying of the bladder is provided by two segmental reflex arcs (parasympathetic and somatic). The irritation from stretching its walls along the afferent fibers of the pelvic nerve is transmitted to the spinal cord to the parasympathetic cells of the sacral segments of the spinal cord, impulses along the efferent fibers lead to a 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 sections of the urethra include another reflex arc for the external (striated) sphincter, which, when relaxed, releases urine. This is how the bladder functions in newborns. In the future, in connection with the maturation of the suprasegmental apparatus, conditioned reflexes are also developed, a sensation of the urge to urinate is formed. Typically, such a urge appears with an increase in intravesical pressure by 5 mm Hg. Art. An arbitrary component of the act of urination includes the control of the external urethral sphincter and auxiliary muscles (abdominal muscles, diaphragm, pelvic diaphragm, etc.).
Sensory neurons are located in the intervertebral nodes SI-SIII.
Dendrites pass through the pudendal nerve and terminate in receptors both in the bladder wall and in the sphincters. Axons, together with the posterior roots, reach the spinal cord and, as part of the posterior cords, rise to the medulla oblongata. Further, these paths follow to the gyrus fornicatus (sensory area of urination). Through associative fibers, impulses from this zone are transmitted to the central motor neurons located in the cortex of the paracentral lobe (the motor zone of the bladder is located near the zone of the foot). The axons of these cells in the composition of the pyramidal tract reach the cells of the anterior horns of the sacral segments (SII-SIV). The fibers of peripheral motor neurons, together with the anterior roots, leave the spinal canal, form the pudendal plexus in the pelvic cavity and, as part of n. pudendus; approach the external sphincter. With the contraction of this sphincter, it is possible to voluntarily retain urine in the bladder.
With a bilateral violation of the connections of the cerebral (cortical) zones of the bladder with its spinal centers (this happens with a transverse lesion of the spinal cord at the level of the thoracic and cervical segments), a violation of the function of urination occurs. Such a patient feels neither the urge nor the passage of urine (or catheter) through the urethra and cannot voluntarily control urination. With an acute violation, urinary retention (retentio urinae) occurs first; the bladder overflows with urine and stretches to a large size (its bottom can reach the navel and above);
it can only be emptied with a catheter. In the future, due to an increase in the reflex excitability of the segmental apparatuses of the spinal cord, urinary retention is replaced by periodic incontinence (incontinentio intermittens).
In milder cases, there is an imperative urge to urinate.
In violation of the segmental autonomic innervation of the bladder and sphincters, various urination disorders occur.
Urinary retention occurs when the parasympathetic innervation of m. detrusor vesicae bladder (segments of the spinal cord 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 retain urine, it is released involuntarily, either intermittently 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 overfull, it does not voluntarily empty) and incontinence (urine always flows drop by drop due to mechanical overstretching of the sphincter).
– – –
5. ABE 55. A
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Vegetative disorders: Clinic, diagnosis, treatment / ed. A.M. Veyna. – 2.
M. : LLC "Medical Information Agency", 2003. - 752 p.
Gusev, E.I. Neurology and neurosurgery: textbook. / E.I. Gusev, A.N. Konovalov, G.S.
Burd. - M. : Medicine, 2007. - 611 p.
Zenkov, L.R. Functional Diagnosis of Nervous Diseases: A Guide for 4.
doctors /L.R. Zenkov, M.A. Ronkin. 5th ed. - M. : MEDpress-inform, 2013. - 488 p.
Brief reference book of a neurologist / under. ed. acad. RAMN, prof. A.A.
Skoromets. - M. : MEDpress-inform, 2008. - 576 p.
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Guide for doctors / A.A. Skoromets, T.A. Skoromets. - 4th ed., stereotype. - St. Petersburg. : Polytechnic, 2007. - 399 p.
Topical diagnosis of diseases and traumas of the nervous system. Ed. MM.
Alone. - St. Petersburg. : DEAN, 2010. - 232 p.
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ed. - M. : MEDpress-inform, 2014. - 264 p.
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