ANGIOTROFONEVROZA (angiotrophoneurosis, singular; Greek angeion — a vessel, trophz — food + neurosises; synonym: vegetovascular neurosises, vascular and trophic neurosises, vascular and trophic neuropathies) — the diseases developing owing to dynamic frustration of a vasculomotor and trophic innervation of bodies and fabrics.
Matters hereditary predisposition, constitutional inferiority of a vasculomotor innervation, on to-ruyu various exogenous factors — infections, intoxications inorganic compounds (lead, mercury, manganese), hron accumulate. alcoholic poisonings, nicotine, ergot, impact of cold. In an origin Angiotrofonevrozov can play a part of disbolism, disorders of activity of hemadens, and also vascular and trophic disorders of allergic character.
Vasculomotor and trophic frustration at cervical osteochondrosis are described. At injuries of the central and peripheral nervous system, at bruises of vessels of extremities, at cortical, hypothalamic and trunk disturbances some syndromes can develop And. Nek-roye in emergence Angiotrofonevrozov can matter as well a mental injury. Cases of development of vasculomotor and trophic disorders of skin in people are known during a hypnotic dream.
Pathogeny difficult. At Angiotrofonevrozakh function of the devices of a vasculomotor and trophic innervation located at various levels of a nervous system is broken. Disturbance of influences of a reticular formation of a trunk of a brain, vasomotor nervous devices matters (see. Autonomic nervous system , Reticular formation ), and also functions of the nervous device regulating a trophicity of fabrics and consisting of the sympathetic and parasympathetic neurons going from bark to the periphery. L. A. Orbeli pointed to adaptation and trophic influence of sympathetic system on metabolism in fabrics. To development of separate forms A. endocrine frustration can promote (a thyroid gland, adrenal glands, etc.) that is in many respects caused by disturbance of nervous control of functions of these glands. Local factors — cooling, vibration, a muscular overstrain — often serve as the provocative moments. Definition at what level of a nervous system disturbance — bark takes place, a hypothalamus, a trunk, a spinal cord, peripheral nervous educations — is necessary for purposeful therapy.
The clinical picture
Symptomatology Angiotrofonevrozov is various. At one patients vasculomotor frustration, at others — trophic, and at the third that and others prevail. At some forms A. the spasm takes place, at others — vasodilatation, and at some patients the combination or bystry change of these states comes to light. In many cases there is a disturbance of hydrophily of fabrics with development of local hypostasis. At And. syndromes of disturbance of blood circulation and the dystrophic phenomena in extremities are almost always observed. Can be And. skin, hypodermic cellulose and deep tissues of extremities, and also person and trunk.
Often spastic forms A meet., e.g. a Raynaud's disease (see. Reynaud disease ), edges it is characterized by attacks of disturbance of a vasculomotor innervation, most often distal parts of extremities (fig. 1 — 3). Reynaud's syndrome unlike a Raynaud's disease having secondary character often is an initial symptom of a system scleroderma. At these patients the expressed vasospasm of extremities, trophic changes of skin, nails, numbness and blanching of a brush and fingers are noted.
Less expressed forms Angiotrofonevrozov are Crocq's disease (see) and akroasfiksiya. At patients cyanosis of hands, their cold snap, a hyperhidrosis, and also an atrophy or a hypertrophy of fabrics is noted. A common angiospastic form A, the acroparesthesias described to F. Schultze — existence of paresthesia, often bilateral, symmetric on palms and forearms, sometimes without decolourizations and temperature of skin, sometimes the painful paresthesias like numbness developing usually in the second half of night are. In some cases blanching or a dermahemia, a slight hypesthesia comes to light. The phenomena of an acrotrophoneurosis in distal departments of hands are described at cervical osteochondrosis (see).
From forms Angiotrofonevrozov which cornerstone vasodilatation is holds a specific place eritromelalgiya (see), characterized by expansion during an attack of arterioles and capillaries, and an akroeritroza; the last are expressed in painless reddening of distal parts of extremities, is more often than hands, owing to sharp expansion of arterioles and capillaries.
It is quite often possible to meet at And. the hypostases depending on the strengthened transmission of plasma walls of capillaries in surrounding fabric.
Carry an acute local Quincke's edema to this group (see. Quincke hypostasis ) and small tortoiseshell (see) not allergic genesis. These hypostases often develop on a face. Standing often the trophedema of Meyzha which is characterized by dense cutaneous dropsies and hypodermic cellulose develops. Changes of skin and hypodermic cellulose are found at dermatomyositis (see), at Krom the erythema, rashes, hypostases, sites of an atrophy of skin and hypodermic cellulose with preferential localization of these changes on a face, a neck, a breast, forearms, palms and fingers of hands are observed.
Angiotrofonevrozov enters into separate group a lipodystrophy (see), development a cut is characterized by an atrophy of a hypodermic fatty tissue only of an upper half of a body.
Are described cold Angiotrofonevroza among which it should be noted the holodovy erythrocyanosis which is found at young girls of 16 — 19 years. Characteristic signs — cold legs, marble coloring of skin in hot and cold time. The «trench foot» which is found at the soldiers who were long in entrenchments concerns to the same group. To the same group A. it is necessary to carry «foot of the miner» — occupational disease when the worker stays long with the bent legs, sometimes in water that leads to vazomotornotrofichesky frustration on feet.
To professional And. belong also Angiotrofonevroza, developing at vibration disease (see); sometimes in the first months of work with the vibrating tool workers have symptoms And. hands in the form of an acroparesthesia, pain, skin of brushes of a tsianotichn, is sometimes edematous; at influence by a cold water skin of fingers becomes in a deathlike way pale. In development of these changes the combination of local adverse factors (vibration) with disturbance of nervous control of a tone of vessels plays a role.
Are described Angiotrofonevroza of internals, however at the same time not only vasculomotor and trophic frustration, but also and disturbances of a motive and secretory innervation are observed that is expressed in defeats of functions of a respiratory organs (vasculomotor rhinitis), went. - kish. path (disturbance of secretion of a stomach, ulcer, colitis), etc. Vasculomotor frustration in a brain, its covers and sense bodys are expressed in such diseases as migraine (see) or a menyerovsky syndrome (see. Menyera disease ).
In diagnosis And. the important place is taken by objective methods of a research: measurement of skin temperature electric thermocouple or electronic thermograph, oscillography, pletizmografiya, research of a skin and galvanic reflex, kapillyaroskopiya and arteriography of peripheral vessels.
The forecast is defined by the nature of a disease and degree of clinical symptoms. The favorable forecast at a Crocq's disease, early stages of a vibration disease. At some other forms (an eritromelalgiya, a Raynaud's disease) changes can have resistant character.
At Ampere-second dominance of a vasospasm applies antispasmodics (Platyphyllinum, a papaverine, nicotinic to - that, Dibazolum), ganglioblokator (Pachycarpinum, Gangleronum, Pentaminum), B12 vitamin. From balneofizioterapevtichesky actions it is reasonable to appoint galvanic collars on Shcherbaka, two-chamber plating baths, an electrosleep, hydrosulphuric and radonic bathtubs, uv radiation paravertebralno at the level of ThI — ThV or ThX — LII. At And. the upper extremities tied with a vibration disease recommend mud applications of contrast temperatures: imposing of sapropelic dirt on a brush in the form of short gloves (t ° 46 — 50 °), applications in the form of a collar to the middle of shovels with capture over - and subclavial area (t ° 26 — 28 °). Duration of the procedure 15 — 20 min. every other day, 10 — 12 procedures.
Treatment in resorts with hydrogen-sulfide waters (Matsesta, Pyatigorsk, Sernovodsk), radioactive waters (Tsqaltubo, Belokurikha), mud cure [Saky, Yevpatoria, Tinaki, Odessa (estuaries)] is recommended. Some effect gives intravenous administration of novocaine, novocainic blockade of nodes of a sympathetic trunk of ThII — ThIV at damage of upper extremities and lower extremities, the LI—LII at defeat. In persistent cases use of a roentgenotherapy with radiation of the same sympathetic nodes is shown. In the absence of effect of conservative therapy it is necessary to resort to an operative measure. Big distribution was gained by operation of preganglionic sympathectomies (see), at a cut bonds of the nodes innervating the struck bodies and fabrics with c are interrupted. N of page by removal of a part of a sympathetic trunk between the spinal centers and the node which is directly sending fibers to this struck area. The preganglionic sympathectomy gives more lasting effect, than ganglionic. At And. upper extremities the preganglionic sympathectomy becomes at the level of ThII — ThIII, and at And. the lower extremities — at the level of LI — LII. At acroparesthesias use of vasodilating drugs and gymnastics of vessels is recommended (use for brushes and feet of cold and hot bathtubs alternately). At Ampere-second dominance of a vazodilatation use the drugs narrowing peripheral vessels (caffeine, ephedrine, Ergotinum), drugs of calcium, ascorbic to - that, rat anti-acrodynia factor. Sometimes the effect can be gained during the use of novocainic blockade of sympathetic nodes (a break not only the vasculomotor, but also receptor fibers going from deep tissues and vascular walls of extremities). At And., the kollagenoz accompanying an initial stage — a system scleroderma and a dermatomyositis — treatment of a basic disease using glucocorticoid therapy (Prednisolonum, Prednisonum) in therapeutic doses, anabolic steroids, antibiotics is recommended.
Prevention consists first of all in elimination of the reasons, defiant And. With harmful production factors it is necessary to change temporarily or constantly kind of work. At Holodov A. it is necessary to avoid cooling, to wear warm clothes and shoes. It is necessary to care for the correct organization of work and rest and normalization of a dream also. At allergic states it is necessary to exclude the sensibilizing factors.
Bibliography: Bondarchuk A. V. Diseases of peripheral vessels, from 116 L of 1969; Grinstein A. M. and Popov N. A. Vegetative syndromes, page 282, M., 1971; Mikheyev V. V. Collagenoses in clinic of nervous diseases, page 137 164, M., 1971; Pavlov I. P. Complete works, t. 3, kN 2 from 147 t of the 4th page 299, M. — L., 1951; Popelyansky N. Yu. Cervical osteochondrosis, with 71 M of 1966; Rusetsky I. I. Vegetative nervous disturbances, page 96, etc., M., 1958; Tareev E. M. Collagenoses, page 162, 267, M., 1965; Chetverikov N. S. Diseases of the autonomic nervous system, page 46, etc., M., 1968; Aita J. A The neurologic manifestations of collagen diseases, Neb. med. J., v. 48, p. 513, 1963; Kuntz A. The autonomic nervous system, Philadelphia, 1953; Ratschow M. Die peripheren Durchblutungsstörungen, Dresden-Lpz., 1953; Wright I. S. Vascular diseases in clinical practice, Chicago 1952.
D. T. Schaefer.