AUTONOMIC NERVOUS SYSTEM

From Big Medical Encyclopedia

AUTONOMIC NERVOUS SYSTEM [systema nervosum autonomicum (PNA); synonym: autonomous nervous system, visceral nervous system ] — the part of a nervous system regulating activity of interiors, glands, circulatory and limf, vessels, smooth and partly cross-striped muscles. It develops of the central and peripheral departments.

History

In 1732 Zh. Vinslou, believing that the innervating internals of a branch of a boundary trunk carry out feelings, appropriated to a trunk and its branches the name «sympathetic» (grech, sympatheia a community of feelings). The fr. doctor M. Bisha in 1801 suggested to divide functions of an organism on animalny, or somatic, and vegetative, or visceral. Under the first it was offered to understand perception of irritations from the environment and motor reactions of skeletal muscles, and under the second — a metabolism and the functions (breath, blood circulation, digestion, allocation, reproduction etc.) which are closely connected with its maintenance. Respectively the somatic nervous system provides touch and motor functions, and vegetative (the term is entered M. Bisha in 1801), or a visceral, nervous system [the term is offered by Gaskell (W. N of Gaskell) in 1886] innervates internals, vessels and glands. The term «visceral nervous system» does not reflect V.'s participation N of page in an innervation of skeletal muscles and distantny analyzers.

The fact that activity of a somatic nervous system in much bigger degree, than vegetative, is perceived and controlled by consciousness found reflection in the terms «autonomous nervous system» (D. Langley, 1903) and «an involuntary nervous system» (Gaskell, 1916). In the same time on the basis of a different arrangement intra-both extramural gangliyev and various pharmacological sensitivity to sincaline and D. Langley's nicotine suggested to distinguish sympathetic and parasympathetic departments of V. of N of page. Though any of the provided names does not cover completely main features of V. of N of page, these terms are widely applied.

Anatomy

Fig. 1. The scheme of an arrangement of the sympathetic and parasympathetic centers in a head and spinal cord and the course of parasympathetic fibers in III, VII, IX and X nerves (III — n. oculomotorius; VII \n. n. n. facialis; XI \n.glossopharyngeus;;;;;;;;; X \n.vagus n.vagus): I \4444444 4 — the centers of the vegetative centers of a trunk of a head and spinal cord, 1 — mesencephalon; 2 — medulla oblongata; 3 — the sympathetic centers in a spinal cord; 4 — the parasympathetic centers in a spinal cord (sacral department); 5 — nn. splanchnici pelvini; 6 — plexus hypogastrica (nerves to a rectum, a bladder, generative organs); 7 — plexus celiacus (nerves to a stomach, intestines, a liver, a pancreas, kidneys, adrenal glands, a spleen); 8 — nerves to heart, a bronchial tube (lung); 9 — gangl. submandibulare (nerves to submaxillary and hypoglossal glands); 10 — chorda tympani; 11 — gangl. oticum (nerves to parotid glands); 12 — gangl. pterygopalatinum (nerves to the lacrimal glands); 13 — gangl. ciliare (nerves to a sphincter of a pupil, a ciliary muscle).
Fig. 2. Sympathetic trunk and belly nodes of an embryo of the person of 10,5 mm of length: 1 — a sympathetic trunk; 2 — a throat; 3 — a respiratory tube; 4 — an aortic arch; 5 — a vagus nerve; 6 — a chest aorta; 7 — a gullet; 8 — nn. splanchnici; 9 — a stomach and a texture of vagus nerves on a stomach; 10 — a celiac texture; 11 — and. Omphalomesenterica; 12 — umbilical arteries; 13 — a pelvic part of a sympathetic trunk.
Fig. 1. The scheme of a structure and bonds of the autonomic nervous system (red color — sympathetic nervous cells and fibers, blue — parasympathetic nervous cells and fibers).
Fig. 2. Scheme of an intra barreled structure of a vagus nerve: 1 — nucleus dorsalis; 2 — nucleus ambiguus; 3 — nucleus tractus solitarii; 4 — gangl, superius; 5 — gangl, inferius; 6 — an intra barreled afferent nervous cell; 7 — an intra barreled vegetative (parasympathetic) nervous cell; 8 — gangl, spinale; P — truncus sympaticus; 10 — an intramural parasympathetic nervous cell of a wall of a stomach; 11 — gangl, coeliacum; 12 — nucleus intermediolateralis. Orange solid line — efferent animalny fibers; a blue solid line — parasympathetic preganglionic fibers; a blue dashed line — parasympathetic postganglionic fibers; a green solid line — sympathetic preganglionic fibers; a green dashed line — sympathetic postganglionic fibers; a red solid line — afferent (bulbar and spinal) fibers; a black dashed line — the recurrent (ascending) fibers. Began them and a further way are not studied yet.
Fig. 3. Course of fibers of spinal nerves and their communication with a sympathetic trunk (scheme): 1 — canalis centralis; 2 — commissura ant. grisea; 3 — fissura mediana ant.; 4 — cornu ant.; 5 — r. communicans albus (fibrae preganglionares to ganglion prevertebrale); 6 — r. communicans albus (fibrae preganglionares to ganglion vertebrale); 7 — fibrae postganglionares from ganglion vertebrale; 8 — fibrae postganglionares from ganglion prevertebrale; 9 — body (gut); 10 — ganglion prevertebrale; 11 — fibrae preganglionares to ganglion prevertebrale; 12 — fibrae postganglionares; 13 — ganglion vertebrale; 14 — r. interganglionaris; 15 — afferent fibers (viscerosensory); 16 — r. communicans griseus (fibrae postganglionares to n. spinalis); 17 — skin; 18 — a muscle; 19 — r. ventralis (r. anterior); 20 — motive fibers of cells of a front horn of a spinal cord; 21 — of dorsalis (of posterior); 22 — a muscle; 23 — skin; 24 — afferent fibers; 25 — n. spinalis; 26 — ganglion spinale; 27 — radix dorsalis; 28 — radix ventralis; 29 — cornu post.

The central part B. of N of page is constructed hierarchically. The position of the vegetative center in hierarchy is higher, the sphere of its regulatory influences is wider. The highest vegetative centers of a cerebral cortex provide somato-vegetative integration in the course of adaptive activity of an organism. There are Hypothalamic centers responsible for maintenance of relative constancy of internal environment below (see. Homeostasis ). The hypothalamus sends nerve fibrils to the centers of a trunk of a head and spinal cord which provide reflex regulation of breath, blood circulation and other vital functions. The vegetative centers of a trunk of a head and spinal cord are located with four separate centers (fig. 1): 1) mezentsefalicheskiya, from to-rogo nerve fibrils leave as a part of a third cranial nerve; 2) bulbar, from to-rogo autonomous nerve fibrils leave as a part of intermediate the glossopalatine and wandering cranial nerves; 3) thoracolumbar — kernels of side horns of C8-L3 of segments; 4) sacral — kernels of side horns of S2 — S4 of segments; leave two last centers of fiber as a part of ventral roots of spinal nerves. Motor impulses, coming from the trunk and spinal centers, reach interiors and vessels on a two-neural way. The first neurons (neurocytes) are located in a head or spinal cord, their shoots go to peripheral nodes B. of N of page and terminate on bodies of the second neurocytes. Shoots of the second neurons branch in the innervated bodies (tsvetn. fig. 1 and 2). Shoots of the first neurons are called preganglionic fibers, and shoots of the second — postganglionic. The thoracolumbar spinal centers arising in them preganglionic fibers and corresponding to them nodes and also postganglionic fibers make sympathetic part B. of N of page [pars sympathica (PNA), systema nervorum sympathicum (BNA, JNA)]. Sympathetic fibers come out a spinal cord as a part of ventral roots and get into spinal nerves (tsvetn. fig. 3). After escaping of the vertebral channel preganglionic fibers enter in the form of white connecting branches (rr. communicantes albi) in peripheral vegetative sympathetic nodes. These nodes are located two chains lying on both parties of a rachis and form sympathetic trunks (trunci sympathici). They contain sympathetic neurons which shoots (postganglionic fibers) go directly to interiors and blood vessels or are returned to structure of spinal nerves in the form of gray connecting branches (rr. communicantes grisei), together with them reaching blood vessels, unstriated muscles and glands of a body and extremities.

The centers located in a trunk of a brain and sacral segments of a spinal cord the preganglionic fibers coming from them and also nerve knots with the postganglionic fibers which are coming out them form a parasympathetic part, or a parasympathetic nervous system [pars parasympathica (PNA), systema nervorum parasympathicum (JNA)]. Nodes, to the Crimea go parasympathetic preganglionic fibers, are located close or in a wall of the innervated bodies therefore short postganglionic parasympathetic fibers. Parasympathetic part B. of N of page has more limited in comparison with sympathetic area of an innervation. One part of bodies has double (parasympathetic and sympathetic), and another — only a sympathetic innervation.

A sympathetic part of the autonomic nervous system

Embryology

the Sympathetic nervous system comes from an ectoderm and arises along with laying of a spinal cord. In the first weeks of an antenatal life still undifferentiated cells of side parts of truncal segments of a brain tube from Th1 to L2-3 of a segment [Harmann, across Langley — to L4] begin to be allocated: according to A. Kuntz — a part from spinal nodes, according to Müller and Ingvar (L. Muller, S. Ingvar) — from spinal nodes and a ganglionic plate. They follow in the direction of the next piece of ventral roots of a spinal cord (according to A. Kuntz, front and back) and at a four-week germ, having left a root, are located with two columns lateralno and dorsalno from an aorta along the developing backbone — future sympathetic trunks. According to Bart (L. G. Barth, 1941), A. G. Knorre and L. V. Suvorova (1961), etc. neuroblasts of ganglionic plates migrate ventrally, forming sympathetic nodes. A part of cells moves towards internals. Nervous cells of some sympathetic nodes form fibers after short circuit of a neurotubule (N. I. Zazybin, 1936).

Researches D. M. It is blue and soavt. in 1940 — 1970 showed existence of a number of stages in development of various departments of a sympathetic nervous system. Laying of a nervnovoloknisty component of a sympathetic trunk is formed by fibers of ventral and back roots of a spinal cord (preganglionic sympathetic and afferent spinal fibers). Since upper chest segments, visceral branches depart from laying of a sympathetic trunk; they unite among themselves on each side aortas and form tyazh, located ventralny a sympathetic trunk, being a basis of prevertebral neuroplexes of an abdominal cavity. Tyazh goes caudally and at a germ, since 17 mm of length, grows into laying of pelvic neuroplex. Nerve fibrils from upper chest segments grow also into the area of a neck and form a basis of cervical department of a sympathetic trunk.

The Nervnokletochny component of sympathetic system is put on border between cervical and chest areas in the form of three friable accumulations of neuroblasts: one — kaudalny laying of a subclavial artery and two — kranialny it. Then segmented nodes of cervical area merge in continuous cellular tyazh, going kranialno on the course of an internal carotid artery. At a germ of 13,5 mm of length this tyazh is thickened, creates upper in the beginning, and then average and cervicothoracic (star-shaped) nodes.

In chest department laying of a sympathetic trunk arises in the form of segmented nodes. Already at a germ of 10,5 mm of length their merge in a cellular tyazh begins, from a ventral part to-rogo prevertebral textures of an abdominal cavity (fig. 2) form. Further at a germ of 13,5 mm of length the chest department concentrates in the form of a cellular tyazh, in Krom much later (a germ of 55 mm of length) it is possible to see the alternating expansions and narrowings. At a fruit of 6 months. (L. U. Turdyev, 1972) division of a sympathetic trunk into definitivny nodes clearly is planned.

Approximately the same stages of development there passes the lumbar department of a sympathetic trunk, only its partition on definitivny nodes occurs considerably later.

The sacral department passes three stages in the development. At germs And yes 12 mm of length appear groups of neuroblasts (primary nodes). Nerve fibrils burgeon in them from the developing lumbar department. Primary nodes of sacral department also form kletochnovoloknisty tyazh, on the course to-rogo secondary or definitivny nodes come to light further. This process is less expressed and is carried out later, than in overlying departments.

Laying of prevertebral textures of an abdominal cavity is located on a lobby and side surfaces of an aorta and represents visceral branches of a sympathetic trunk. Loops of textures contain not numerous neuroblasts.

Quickly enough (a germ of 11 mm of length) textures are outlined in a uniform bookmark celiac, belly aortal and upper hypogastric. The celiac texture is entered by the big splanchnic (celiac) nerves forming due to concentration of cranial group of visceral branches of a sympathetic trunk.

On the course of big splanchnic nerves before their entry into thickness of laying of celiac nodes the splanchnic node comes to light (gangl. splanchnicum — at a germ of 33 mm of length). Laying of a belly aortal texture burgeons caudally and gets into a pelvic texture, having throughout accumulation of neuroblasts.

Fig. 3. An embryo of the person of 15 mm of length (cross section at the level of lumbar segments): 1 — a spinal node; 2 — a ventral root; 3 — a spinal nerve; 4 — laying of a body of a vertebra; 5 — a node of a sympathetic trunk (graphic reconstruction on glass; X 75); 6 — decussation of the right and left branches on a front surface of a ventral aorta; 7 — a visceral branch of a sympathetic trunk; 8 — a ventral aorta.

In an embryogenesis of the person as a part of sympathetic system formation of cross bonds is observed. Decussation is made by the branches departing on both sides from spinal nerves; they pass by a sympathetic trunk and are connected with nodes nerve fibrils. The right and left branches form decussation on a front surface of a ventral aorta. The site of each branch on an extent from the mixed nerve to a sympathetic trunk represents a white connecting branch (a visceral branch). These decussations are located between symmetric vegetative educations on an extent from a diaphragm to the bottom of a basin and form the system of cross bonds which is morfol, substrate of a bilateral innervation of internals (fig. 3).

Structure

Fig. 4. Nerves and neuroplexes of bodies of a chest cavity, on the right (the pristenochny leaf of a pleura and an intrathoracic fascia, a liver and partially a diaphragm are removed; the right lung is delayed to the left): 1 — a. carotis ext.; 2 — n. hypoglossus; 3 — the item vagus (cervical department); 4 — a. carotis communis; 5 — glandula thyreoidea; 6 — trachea; 7 — truncus brachiocephalicus; 8 — v. cava sup.; 9 — n. vagus (chest department); 10 — rr. pulmonales n. vagi; 11 — esophagus; 12 — pulmo (it is delayed to the left); 13 — plexus esophageus; 14 — aorta thoracica; 15 — diaphragma; 16 — truncus vagalis ant.; 17 — ventriculus; 18 — plexus gastricus ant.; 19 — truncus celiacus; 20 — duodenum; 21 — pancreas; 22 — plexus celiacus; 23 — n. splanchnicus minor; 24 — truncus vagalis post.; 25 — m. subcostalis; 26 — n. splanchnicus major; 27 — truncus sympathicus; 28 — nn. intercostales; 29 — rr. communicantes; 30 — a. intercostalis post; 31 — v. azygos; 32 — ganglion thoracicum trunci sympathici; 33 — n. laryngeus recurrens; 34 — a. subclavia; 3 5 — ganglion cervicothoracicum; 36 — plexus brachialis; 37 — ganglion cervicale medium; 38 — m. scalenus ant.; 39 — truncus sympathicus; 40 — n. phrenicus; 41 — n. spinalis III; 42 — ganglion cervicale sup.; 43 — a. carotis int.
Fig. 5. Nerves and neuroplexes of bodies of a chest cavity, at the left (the pristenochny leaf of a pleura and an intrathoracic fascia are removed; the left lung is taken away to the right): 1 — plexus cervicalis; 2 — n. phrenicus; 3 — gangl. cervicale medium trunci sympathici; 4 — plexus brachialis; 5 — a. subclavia; 6 — costa I; 7 — nn. cardiaci cervicales inf.; 8 — arcus aortae; 9 — n. laryngeus recurrens; 10 — aorta thoracica; 11 — esophagus; 12 — n. intercostalis VII; 13 — truncus sympathicus (chest department); 14 — v. intercostalis post.; 15 — v. hemiazygos; 16 — a. intercostalis post.; 17 — gangl. thoracale Х trunci sympathici; 18 — rr. gastrici ant. (plexus gastricus ant.); 19 — ventriculus; 20 — plexus celiacus; 21 — truncus vagalis ant.; 22 — v. cava inf.; 23 — diaphragma; 24 — n. splanchnicus major; 25 — plexus esophageus; 26 — pulmo sin.; 27 — plexus pulmonalis (rr. pulmona-les nn. vagi); 28 — rr. cardiaci sup. (rr. cardiaci n. vagi); 29 — n. vagus; 30 — n. cardiacus cervicalis med.; 31 — a. carotis communis; 32 — truncus sympathicus; 33 — r. communicans to plexus cervicalis; 34 — a. lingualis; 35 — a. carotis int.; 36 — a. facialis; 37 — ganglion cervicale superius trunci sympathici; 38 — a. carotis ext.


The central part of a sympathetic nervous system is presented by the intermediate and lateral kernel (nuci, intermediolateralis) which is located in side horns of a spinal cord from C8 to L3 of a segment and consisting preferential of small star-shaped cells. Shoots of neurons of this kernel as a part of ventral roots go through spinal nerves and white connecting branches to nodes of sympathetic trunks, celiac, mesenteric and other textures. Sympathetic trunks of the adult represent the nodes (ganglia trunci sympathici) connected by internodal branches (rr. interganglionares) and going on each side a rachis from a base of skull to a tailbone. A cervical part includes nodes: upper (gangl. cervicale sup.), average (gangl. cervicale med.), non-constant vertebral (gangl. vertebrale) and cervicothoracic, or star-shaped (gangl. cervicothoracicum, s. stellatum — PNA). B exceptional cases are available isolated lower cervical and upper chest nodes. The upper cervical node — an ovate-oblong form, lies at the level of bodies of the II—III cervical vertebrae, behind an internal carotid artery (tsvetn. fig. 4 and 5); it is sometimes closely connected to the lower node of a vagus nerve and difficult from it is separable [according to Fick in 4 cases from 28]. The average cervical node is located at the level of cross shoots of the V—VI cervical vertebrae ahead of a long muscle of a neck and adjoins to the lower thyroid artery. It differs in an extraordinary variation of forms, can sometimes be absent. The second internodal branch of a trunk forms a loop around a subclavial artery [ansa subclavia (PNA, JNA), ansa subclavia Vieussenii (BNA)], occasionally — around thyroid (ansa thyroidea).

Chest part consists of 10 — 12 nodes (ganglia thoracica), is covered with a leaf of an intrathoracic fascia and a costal pleura. These nodes have the triangular or square form and lie ahead of heads of edges.

Belly (or lumbar) a part with its 4 — 5 lumbar nodes (gan glia lumbalia) lies on bodies of vertebrae, on the right is covered with the lower vena cava, at the left — an aorta.

A sacral part — the shortest, is located medially from pelvic sacral openings, includes 3 — 4 nodes (ganglia sacralia).

The right and left trunks at the level of I coccygeal vertebra connect and form a loop, on the middle the cut is located a small unpaired coccygeal node (gangl. coccygeum impar).

Fig. 4. The header of the autonomic nervous system (sympathetic fibers are represented by solid lines, parasympathetic — a dotted line): 1 — a. carotis int.; 2 — r. sympathicus ad gangl. ciliare; 3 — r. communicans cum n. nasociliari; 4 — n. frontalis; 5 — gl. lacrimalis; 6 — n. ciliaris longus; 7 — n. ciliaris brevis; 8 — bulbus oculi; 9 — gangl. ciliare; 10 — radix oculomotoria; 11 — parasympathetic fibers to the lacrimal gland; 12 — gangl. pterygopalatinum; 13 — n. petrosus prof.; 14 — nn. palatini; 15 — gangl. oticum; 16 — n. lingualis; 17 — gangl. submandibulare; 18 — gangl. sublinguale; 19 — gl. sublingualis; 20 — gl. submandibularis; 21 — a.facialis; 22 — n. alveolaris inf.; 23 — plexus caroticus ext.; 24 — a. carotis ext.; 25 — a. carotis communis; 26 — truncus sympathicus; 27 — nn. carotici ext.; 28 — gangl. cervicale sup.; 29 — chorda tympani; 30 — n. caroticus int.; 31 — gl. parotis; 32 — n. auriculotemporalis; 33 — n. glossopharyngeus; 34 — n. facialis; 35 — n. tympanicus; 36 — plexus tympanicus; 37 — n. petrosus minor; 38 — n. petrosus major; 39 — gangl. trigeminale; 40 — n. maxillaris; 41 — n. oculomotorius; 42 — n. ophthalmicus; 43 — plexus caroticus int.

Sympathetic nerves of the head, neck and breast depart from cervical and chest nodes, partly from their internodal branches. Nerves of the head (fig. 4) begin from upper and to a lesser extent from cervicothoracic nodes and are divided into two groups. The first consists of jugular (n. jugularis) and internal sleepy (n. caroticus int.) nerves. The last enters a texture on the course of an internal carotid artery.

Branches to an upper node wandering and to the lower node glossopalatine nerves depart from a jugular nerve; from an internal sleepy texture (plexus caroticus int.) — top and bottom caroticotympanic nerves (nn. caroticotympanici sup. et inf.), and also the textures accompanying branches of an internal carotid artery. Taking place in a cavernous sine, the internal sleepy texture receives the name cavernous, in structure to-rogo nervous cells are found (S. S. Mikhaylov, 1965). The texture sends branches to the oculomotor, block, taking-away nerves, a node of a trifacial, a hypophysis and to a cavity of an eye-socket (to the lacrimal gland, a ciliary node, the muscle expanding a pupil). The vertebral texture (plexus vertebralis) knotted with cervicothoracic and accompanying a vertebral artery concerns to the same group of nerves. Internal sleepy and vertebral textures exchange branches in a skull, give also branches to covers and vessels of a brain. The second group of sympathetic nerves of the head is formed by two branches of an upper cervical node (nn. carotici ext.), accompanying branchings of an outside carotid artery (plexus caroticus ext.). A part of its branches gets in a skull on an average meningeal artery and gives a stipitate to an ear node; the front texture (plexus facialis) on the course of a facial artery gives a branch to a submandibular node.

Fig. 7. Nerves of a neck and breast; behind (the rachis and back departments of edges are removed; lungs are delayed in the parties; the chest aorta, a back wall of a throat and a pristenochny leaf of a pleura are partially removed): 1 — gangl. inf. n. vagi; 2 — gangl. cervicale sup.; 3 — pharynx (is opened); 4 — epiglottis; 5 — v. jugularis int. dext.; — plexus pharyngeus; 7 and 15 — n. vagus dext.; 8 — truncus sympathicus dext.; 9 — a. carotis communis dext.; 10 — gangl. cervicale med.; 11 — a. thyreoidea inf.; 12 — n. laryngeus recurrens dext.; 13 — a. subclavia dext.; 14 — gangl. cervicale inf.; 16 — v. azygos; 17 — bronchus principalis dext.; 18 — vv. pulmonales; 19 — plexus esophageus; 20 — v. cava inf.; 21 — esophagus; 22 — diaphragma; 23 — aorta; 24 — a. intercostalis post.; 25 — plexus aorticus thoracicus; 26 — plexus pulmonalis; 27 and 40 — n. vagus sin.; 28 — bronchus principalis sin.; 29 — a. pulmonalis; 30 — rr. bronchiales; 31 — arcus aortae; 32 — a. subclavia sin.; 33 — pulmo sin.; 34 — n. laryngeus recurrens sin.; 35 — a. carotis communis sin.; 36 — trachea; 37 — v. jugularis int. sinistra; 38 — esophagus; 39 — glandula thyreoidea; 41 — n. laryngeus sup.; 42 — rr. linguales n. glossopharyngei; 43 — n. hypoglossus; 44 — n. glossopharyngeus; 45 — choana.
Fig. 8. Nerves of heart; in front (lungs at a root, an upper vena cava, an aorta and a pulmonary trunk at the basis are removed): 1 — n. cardiacus cervicalis sup. sin.; 2 — plexus cervicalis sin.; 3 — truncus sympathicus sin.; 4 — n. vagus sin.; 5 — n. phrenicus sin.; 6 — m. scalenus ant.; 7 — trachea; 8 — plexus brachialis sin.; 9 — a. subclavia sin.; 10 — n. cardiacus inf. sin.; 11 — truncus brachiocephalicus; 12 — a. carotis communis sin.; 13 — arcus aortae; 14 — n. laryngeus recurrens sin.; 15 — a. pulmonalis sin.; 16 — plexus atriorum ant.; 17 — vv. pulmonales; 18 — auricula sin.; 19 — truncus pulmonalis; 20 — a. coronaria sin.; 21 — plexus ant. sin.; 22 — ventriculus sin.; 23 — ventriculus dext.; 24 — plexus ant. dext.; 25 — a. coronaria dext.; 26 — auricula dext, (is delayed); 27 — aorta (is cut); 28 — v. cava sup. it (is cut); 29 — a. pulmonalis dext.; 30 — v.azygos; 31 — n. cardiacus inf. dext.; 32 — n. laryngeus recurrens dext.; 33 — ganglion thoracicum I dext.; 34 — ganglion cervicale inferius dext.; 35 — n. vagus dext.; 36 — n. cardiacus cervicalis sup. dext.; 37 — n. laryngeus sup.

Bodies of a neck receive nerves from all cervical nodes, partially from textures around the general and outside carotid arteries. Branches of a cervical part of a sympathetic trunk are laryngopharyngeal (rr. laryngopharyngei) which from an upper cervical node a part go with a branch of a vagus nerve (n. laryngeus sup.) to a throat, and a part go down to a sidewall of a throat where together with branches glossopalatine, wandering and upper guttural nerves form a pharyngeal texture (plexus pharyngeus). From there upper, average and lower nerves to heart depart (nn. cardiaci cervicales sup., med. et inf.), their branches accompany upper and returnable guttural nerves (tsvetn. fig. 7 and 8). The phrenic nerve also receives branches from a sympathetic trunk. Textures of bodies of a chest cavity are formed of branches of cervical, chest nodes, branches of vagus nerves; they are divided into three groups. Branches of upper group depart from upper and average cervical nodes, internodal branches and connect to branches of vagus nerves. Branches of average group originate from a cervicothoracic (star-shaped) node and receive branches from a vagus nerve. Both groups follow on the course of the general sleepy and subclavial arteries. On this piece the texture receives branches of the wandering, vozvratnogortanny nerves and a branch of the lower group formed by branches of a row chest * nodes again.

Fig. 6. Nerves and neuroplexes of bodies of belly and pelvic cavities; in front (the peritoneum, the most part of a stomach, thin and thick guts is removed; the stomach, a duodenum and a pancreas are taken away to the left; the rectum and a bladder are delayed from top to bottom): 1 — ventriculus; 2 — ductus hepaticus communis; 3 — ductus cysticus; 4 — ductus choledochus; 5 — v. portae; 6 — a. mesenterica sup.; 7 — duodenum (it is turned off to the left); 8 — pancreas; 9 — plexus mesentericus sup.; 10 — aorta; 11 — ren sin.; 12 — gangl. mesentericum inf.; 13 — v. mesenterica inf.; 14 — a. mesenterica inf.; 15 — plexus mesentericus inf.; 16 — plexus testicularis; 17 — plexus hypogastrica sup.; 18 — a. iliaca communis; 19 — v. iliaca communis sin.; 20 — ureter sin.; 21 — ganglia sacralia trunci sympathici; 22 — plexus sacralis sin.; 23 — plexus hypogastricus inf. sin.; 24 — plexus rectalis; 25 — a. rectalis sup.; 26 — ductus deferens sin.; 27 — vesica urinaria; 28 — ductus deferens dext.; 29 — rectum; 30 — plexus hypogastricus inf. dext.; 31 — a. et v. sacralis med.; 32 — plexus sacralis dext.; 33 — ureter dext.; 34 — nervous stipitates from plexus hypogastricus sup. to an ureter; 35 — truncus sympathicus dext.; 36 — a. iliaca communis dext.; 37 — v. iliaca communis dext.; 38 — plexus testicularis dext.; 39 — v. cava inf.; 40 — plexus aorticus abdominalis; 41 — ren dext.; 42 — a. et v. renales; 43 — plexus renalis; 44 — gangl. aorticorenale; 45 — glandula Suprarenalis; 46 — plexus celiacus; 47 — plexus diaphragmaticus; 48 — a. lienalis; 49 — a. gastrica sin.; 50 — hepar; 51 — v. cava inf.


In textures of abdominal organs (tsvetn. fig. 6) prevail sympathetic fibers. Nervous conductors are splanchnic nerves (subitem of splanchnici majores et minores) departing from nodes of a chest part of a sympathetic trunk and a large number of branches of a belly part of sympathetic trunks. Branches of vagus nerves take part in an innervation of a stomach and intestines; a part them goes to a celiac texture and to a liver. The big splanchnic (celiac) nerve begins several roots departing, as a rule, from the V—IX, and small — from the X—XI chest nodes; they enter the biggest unpaired texture — celiac, or solar [plexus celiacus (PNA), coeliacus (BNA, JNA), solaris], lying on a front surface of a ventral aorta at the place of an otkhozhdeniye of a celiac trunk. The texture occupies the site between renal arteries and an aortal opening of a diaphragm and includes celiac nodes among which distinguish two largest — right and left (ganglia celiaca). The upper mesenteric texture is connected with this texture (plexus mesentericus sup.), 1 — 2 node (gangl. mesentericum sup.) to-rogo are located over a root of an upper mesenteric artery; its branches, following arteries, enter a wall of a gut. The phrenic, adrenal, renal, yaichkovy or ovarian pair textures accompanying the arteries of the same name depart from a celiac texture. Its unpaired textures and separate branches go to a liver, a spleen, a stomach, a pancreas, and with branches of an upper mesenteric texture — to a pancreas, a small and large intestine to a half cross colonic. The second source of an innervation of abdominal organs — a belly aortal texture (plexus aorticus abdominalis) which is formed trunks of a celiac texture and branches of lumbar sympathetic nodes. It is closely connected with the lower mesenteric texture (plexus mesentericus inf.), innervating the cross and descending colons, sigmoid colonic and upper parts of a rectum. The texture passes in unpaired upper hypogastric (plexus hypogastrica sup.), a cut at the cape forks and further becomes the lower hypogastric or pelvic texture (plexus hypogastricus inf., s. pelvinus).

Between top and bottom mesenteric the intermesenteric nervous path (plexus intermesentericus — PNA) is located with textures. It is located pozadibryushinno, hl. obr. to the left of an aorta, also participates in an innervation of intestines.

Fig. 9. Nerves and neuroplexes of bodies of a pelvic cavity; in front (the sigmoid gut and a uterus with appendages are taken away to the left, the bladder is cut on the sagittal plane): 1 — peritoneum; 2 — plexus aorticus abdominalis; 3 — plexus hypogastricus sup. (n. presacralis); 4 — plexus hypogastricus inf. sin.; 5 — plexus ovaricus; 6 — uterus; 7 — a. uterina; 8 — branches from plexus hypogastricus inf. to a uterus and a vagina; 9 — vagina; 10 — vesica urinaria; 11 — plexus vesicalis; 12 — ureter; 13 — a. rectalis media; 14 — a. pudenda int.; 15 — n. splanchnicus sacralis; implexus sacralis; 17 and 22 — plexus hypogastricus inf. dext.; 18 — a. vesicalis; 19 — a. uterina; 20 — a. umbilicalis; 21 — ganglion trunci sympathici; 23 — ganglion trunci sympathici; 24 — a. iliaca int. dext.; 25 — v. iliaca ext. dext.; 26 — a. iliaca ext. dextra; 27 — a. sacralis mediana; 28 — v. sacralis mediana; 29 — v. iliaca communis sin.; 30 — a. iliaca communis dext.; 31 — ganglion trunci sympathici; 32 — v. ovarica; 33 — a. ovarica; 34 — v. cava inf.; 35 — aorta abdominalis.


All pelvic bodies receive nerves from the lower hypogastric texture (tsvetn. fig. 9). It is formed by branches of sacral sympathetic nodes, branches of the I—III or II—IV sacral spinal nerves, and also branches of the lower mesenteric texture take part in it and represents the plate stretched from a sacrum to a bladder (a nodal plate, on former authors). Distinguish: the anteroinferior department of a plate, the bottom to-rogo goes to a prostate, seed bubbles, a deferent duct and cavernous bodies (at men), upper — to a bladder; the average department, the bottom to-rogo gives branches to a vagina, cavernous bodies of the clitoris, upper — to a uterus and ovaries at women; the back department goes to a rectum.

A parasympathetic part of the autonomic nervous system

the Parasympathetic part of the autonomic nervous system consists of the central and peripheral parts connected by preganglionic fibers. The centers lie in various sites of a head and spinal cord, and peripheral nodes — in head cavities, a breast, a stomach and a basin.

Embryology

Parasympathetic nodes of the head (ciliary, pterygopalatine, ear and submandibular) are closely connected with branches of a trifacial. Most of researchers considers that material, from to-rogo there are these nodes, leaves a trigeminal node (V. Gis, 1889; K. V. Kiselyov, 1936; D. M. Golub, 1962, etc.) - Others allow participation of a node of kolenets (gangl. geniculi) and upper node of a glossopharyngeal nerve (Kuntts, 1920; O. G. Plisan, 1949; V. M. Dechko, 1966). According to A. S. A show off and (1951, 1962), laying of parasympathetic nodes forms the neuroblasts coming from various departments of a brain tube.

Andres and Kauttsky (Andres, Kautzky, 1955) consider that these nodes come from the header of a ganglionic plate.

According to V. M. Dechko, the first the submandibular node, then ciliary, pterygopalatine and ear comes to light.

The structure

the Central part of a parasympathetic nervous system is in a trunk of a brain and in a spinal cord. The parasympathetic kernels located at the level of II — the IV sacral segments, give rise to preganglionic fibers which come out with ventral roots, and as a part of pelvic nerves [(nn. splanchnici pelvini, nn. pelvici (PNA)] go to nodes descending colonic, sigmoid and a rectum, a detruzor of a bladder and an urethra, internal generative organs.

Fig. 5. Embryo of the person of 70 mm of length. Branching of large afferent (spinal) nerve fibrils in an intermuscular texture of a small bowel: 1 — large temnoimpregnirovanny nerve fibril and its branching; 2 — nerve termination in a ganglion of a muscular texture (I. A. Gapeev's drug).

In a myelencephalon the dorsal kernel of a vagus nerve is located (nuci, dorsalis n. vagi), macroscopically defined at the bottom of the IV ventricle as a triangle of a vagus nerve (trigonum n. vagi). Parasympathetic cells of this kernel give rise to the preganglionic fibers going in a vagal trunk to the peripheral nodes put in heart, a stomach, a gut. Vagus nerve (see) carries out parasympathetic influence, the most part of its fibers passes through top and bottom sensitive nodes [gangl. superius (PNA), jugulare (BNA, JNA) of et gangl. inferius (PNA), nodosum (BNA, JNA)], participates in an innervation of bodies of a neck, chest (tsvetn. fig. 4) and belly cavities. The second neurons of a parasympathetic way are in extra-and intraorganny nodes, in nervnokletochny textures, e.g., submucosal and intermuscular textures (plexus submucosus et plexus intermuscularis) went. - kish. path (fig. 5). Slyunootdelitelny parasympathetic fibers originate in an upper slyunootdelitelny kernel (nuci, salivatorius sup.), a cut it is located near a kernel of a facial nerve. They go as a part of an intermediate nerve (n. intermedius) to a facial nerve, and then leave it in the form of a drum string (chorda tympani). The drum string goes to a lingual nerve and further to a submandibular node (gangl. submandibulares, postganglionic fibers to-rogo innervate submandibular and hypoglossal sialadens. Together with slyunootdelitelny there are vasodilating fibers to these glands and a mucous membrane of two thirds of language. A part of preganglionic fibers from an upper slyunootdelitelny kernel goes as a part of a big stony nerve (n. petrosus major), reaching a limit in a pterygopalatine node (gangl. pterygopalatina). Postganglionic fibers as a part of a maxillary nerve (item maxillaris), and then malar (n. zygomaticus) and through connections of the last with the lacrimal nerve (n. lacrimalis) reach the lacrimal gland (gl. lacrimalis). Besides, from a pterygopalatine node all glands of a mucous membrane of a nose and an oral cavity are innervated. Slyunosekretorny and vasculomotor fibers contain also in a glossopharyngeal nerve. Leaving a myelencephalon, the lower slyunootdelitelny kernel (the item salivatorius inf.), as a part of a glossopharyngeal nerve (n. glossopharyngeus) to the lower node (gangl. inf.) and further in a drum nerve (item tympanicus) and small stony (item petrosus minor) as preganglionic fibers, they go to an ear node (gangl. oticum) and from the last as a part of an ear and temporal nerve (n. auriculotemporalis) — to a parotid gland (gl. parotis).

The vegetative centers of a brain

In implementation of vegetative reactions an essential role is played by a reticular formation (formatio reticularis) of a myelencephalon and the bridge, she exerts impact on functions of sympathetic and parasympathetic nerves, participates in regulation of cordial activity and respiratory function of an organism, creates readiness for action, influences a tone of muscles, supports a condition of wakefulness and vigorous activity of a cerebral cortex (see. Reticular formation ).

Fig. 6. A frontal section of a brain at the level of the middle of tuber cinereum: 1 — nuci, caudatus; 2 — columna fornicis; 3 — nuci, paraventricularis; 4 — nuclei tuberales; 5 — nuci, supraopticus; 6 — tractus opticus; 7 — commissura ant.
Fig. 7. A frontal section of a brain at the level of corpora mammillaria: 1 — capsula int.; 2 — thalamus; 3 — corpus mammillare; 4 — substantia nigra; 5 — nuci, subthalamicus; 6 — tractus opticus; 7 — globus pallidus; 8 — capsula ext.; 9 — putamen; 10 — claustrum.
Fig. 8. System of conduction paths corpora mammillaria: 1 — fasc. retroflexus; 2 — commissura post.; 3 — aqueductus cerebri; 4 — nuci, tegmenti; 5 — fasciculus mammillotegmentalls; 6 — corpus mammillare; 7 — tuber cinereum; 8 — fasc. mammillothalamicus; 9 — chiasma opticum; 10 — commissura ant.; 11 — thalamus.

Black substance (substantia nigra) which is located in is of great importance for regulation of vegetative functions mesencephalon (see).

In it distinguish two zones — gustokletochny compact and redkokletochny reticular. Sravnitelnoanatomichesky researches showed that a compact zone — phylogenetic newer in comparison with reticular. Black substance possesses numerous bonds with bark, subcrustal educations — a thalamus (thalamus), a pale sphere (globus pallidus), a subthalamic kernel, a reticular formation, is related to regulation of a tone of cross-striped muscles. E. K. Sepp (1949), proceeding from chemical proximity of melanin and adrenaline, made the assumption of the relation of black substance to sympaticoadrenal system. It is one of the coordinating centers of the act of food. On average a brain there is an additional kernel of a third cranial nerve (nuci, accessorius autonomicus) innervating smooth muscles of an eye, the ciliary muscle and a muscle narrowing a pupil (mm. ciliaris, sphincter pupillae).

Hypothalamus (see) is one of the main areas of a diencephalon and represents the receptive and effective center B. of N of page providing adaptation of an organism to the changing conditions of surrounding and internal environment. Hypothalamic kernels play an essential role in regulation of activity of internals, hemadens, sympathetic and parasympathetic parts B. of N of page, in manifestation of emotions. Subcrustal kernels (corpus striatum) participate in performance of vegetative functions thanks to numerous bonds with a cerebral cortex, subcrustal nodes, a thalamus, kernels of a hypothalamus, a tire of a mesencephalon, black substance and other educations which are a part of extrapyramidal system (fig. 6 — 8). Rings of «feed-back», one of which goes from a kernel having a tail (nuci, caudatus) to a pale sphere, and then to a thalamus and from there to a premotorny zone of bark, are of great importance. Another follows through striopallidal system in a cerebellum. On these neural ways can be given both the exciting, and braking impulses, and thanks to existence of these rings difficult interaction is provided extrapyramidal system (see). The highest level, from to-rogo the Extrapyramidal system originates, bark of hemicerebrums is.

Along with regulation of the movement, a pose, tone of muscles and emotions subcrustal kernels take part in regulation of vegetative functions, in mechanisms of emotional and effective reactions of an organism.

Modern experimental and clinical observations showed a significant role of a hippocampus in mechanisms of visceral functions. After injury of a hippocampus change of motility of a bladder is noted, strengthening or weakening of a vermicular movement went. - kish. path, change of a respiration rate, cordial reductions, level of blood pressure, disturbance of thermal control, coagulability of blood etc. His electric irritation is followed by both sympathetic, and parasympathetic effects. In to limbic system (see), in its devices, integration of somatic, vegetative and affective irritations, but, unlike a hypothalamus is carried out, at irritation of these structures less intensive answers having, however, more integrative character follow. New bark of big hemispheres exerts impact on functions B. of N of page, has representation of vegetative functions in motor, premotorny and orbital zones. Hypothalamic impulses are projected on frontal bark, on a medial surface of a parencephalon (to fields 23 and 24), orbital and frontal fields, a vagal afferentation from respiratory organs and blood circulation — in insular bark, afferent impulses from an abdominal cavity — in a postcentral crinkle. Bark of the central part of a medial surface of a parencephalon (so-called limbic share) is a part of the visceral analyzer, participating in regulation of respiratory, digestive, urinogenital systems, taste and sense of smell, exchange processes etc. P. Mac Lane (1952) on the basis of an electrophysiologic research of «a limbic share» came to a conclusion that this area represents the cortical neuroregulatory center for the guttural and pharyngeal and oral device in implementation of the behavioural reactions connected with food, behavior and giving of vocalizations participates in development of the acid defensive reflex playing a role in regulation of visceral and chemical impact on an organism. In the forefront of «a limbic share» there is a representation of such visceral functions as digestion, breath, hormonal regulation etc., and in the tail — preferential function of the blood circulatory system. Bark of hemicerebrums participates in regulation of vegetative influences on muscular system during the performance of autokinesias. At defeat of fields 4 6 disturbances of motive vasculomotor functions, sweating and reaction of the unstriated muscles raising hair are observed. Efferent impulses from bark, frontal and parietotemporal area go to a hypothalamus and a reticular formation of a brainstem.

The complex of structures front, intermediate and a mesencephalon, the representing anatomic substrate of emotions and motivations, makes limbic system. The central link of formation of each motivation is the hypothalamus (as a result of selective sensitivity of its cells to certain substances of blood). Excitement extends on limbic system from where passes to insulyarny bark and front departments of a cerebral cortex therefore the search behavior forms (K. V. Sudakov, 1963).

In limbic system several circles are allocated, are basic of which:

1) an amygdaloid nucleus (corpus amygdaloideum) — a brain strip (stria terminalis) — a hypothalamus — an amygdaloid nucleus;

2) a hippocampus — the arch — a transparent partition — mastoidal bodies — mastoidal bugorny a bunch — a thalamus — a zone crinkle — a belt (cingulum) — a hippocampus. Allocate some more smaller subsystems which are characterized by certain functions. So, the rostral group of structures including orbital, insular bark and bark of a temporal pole provides preservation of life of this individual. Other group combining a transparent partition, a hippocampus and a zone crinkle generally is related to the functions connected with reproduction (P. Mac Lane, 1955). The limbic system participates in implementation of all main functions B. of N of page. At irritation of its structures in an organism both sympathetic, and parasympathetic mechanisms will be mobilized. E.g., along with increase in blood pressure, increase of serdtsebiyeniye, respiratory movements it is possible to observe also opposite effects. In general the limbic system can be considered as the center of integration of vegetative and somatic components of emotional reactions.

A vegetative innervation of bodies — see articles devoted to separate bodies (e.g., Throat , Stomach , Heart etc.).

Histology

All nodes B. of N of page are formed by accumulations of neurons and glial nervous elements (satellites and oligodendrocytes), bunches and textures of pulpy and amyelenic nerve fibrils, and also connecting fabric with the blood vessels passing in it.

Fig. 9. Multipolar neurons (1); connections of their dendrites — dendritic nests (2) of an upper cervical node of the person (coloring across Bilshovsky — Groce — to Lavrentyev).
Fig. 10. The Dlinnoaksonny neurocyte of a gullet of a dog — is specified by an arrow (coloring across Bilshovsky — Groce — to Lavrentyev)
Fig. 11. Ravnootrostchaty neurocytes (1) of a subserosal texture of a small bowel of a cat (coloring across Bilshovsky — Groce — to Lavrentyev)

At the person and adult mammals all vegetative neurons have several shoots (fig. 9). The shape of a body (perikaryon) of neurons depends on quantity and a way of an otkhozhdeniye of shoots. The size of cells, amount of neurons of different size are not identical in various vegetative gangliya that it depends on age, functional features of the innervated bodies and action of various irritants. So, in nodes of a reproductive system of the person the jump diff of a rentsirovka of V. of N of page by the time of puberty is observed; growth and development of nervous cells continues up to

35 years, and from 43 — 45 years processes of their involution begin. In 65 — 75 years of the phenomenon of an atrophy and destruction of neurons in nodes of a vagina and neck of uterus are expressed sharply (B. I. Lavrentyev, 1938). In other bodies and nodes B. and. the page is observed a gradual differentiation, maturing and involution of neurons. At people 80 years in a celiac node are more senior there are only 7% of normal nervous cells, in the others various dystrophic changes [J. Botar] are found. Age features affect also structure of various components of protoplasm and a kernel of neurons.

The majority of vegetative neurons at the person and adult mammals contains one kernel with one or two kernels. The kernel usually holds central position. In cytoplasm of vegetative neurons allocate various organellas and inclusions. At special methods of processing (impregnation by silver salts) in a neuroplasm the specialized structure of neuron — neurofibrilla comes to light. These are the fine ends representing bunches of microtubules (dl. 20 — 26 nanometers) and neurofilaments (dl. 10 nanometers). In neurites and dendrites of neurofibrilla go in parallel; in places of final expansions there are seteobrazny neurofibrillar structures (B. I. Lavrentyev, 1938). The neuroplasm contains basphilic substance. Data of a submicroscopy confirm that this substance should be considered as nodal points of extensive cytoplasmic granular reticulum, edges penetrates all cytoplasm of neuron and dendrites and is the device of protein synthesis. Depending on a functional condition of neuron distribution and size glybok basphilic substance considerably change. Around a kernel the lamellar complex representing a special agranular form of a cytoplasmic reticulum is located. Neurons vegetative gangliyev contain mitochondrions which easily change a form, the size, can move on protoplasm, as a rule, are absent within basphilic substance. Except organellas, in vegetative neurons products of metabolism — melanin and lipofuscin which appear already at 6 — 7-me-syachnykh human fruits are found and with age quantitatively accrue.

Vegetative neurons are surrounded with the connective tissue capsules covered from within by satellites (amfitsita, gliotsita); shoots of vegetative neurons have a neuroglial cover from oligodendrocytes. Capsules of neurons most clearly are expressed in cranial parasympathetic nodes. Morfol, features of vegetative neurons are dendrites (their type, distribution and the relation to shoots and bodies of other neurons of the same ganglion). It is possible to distinguish clearly three types of vegetative neurons in a form and character of their shoots. This classification offered by A.S. Dogel (1898) is accepted in histology: cells of the I type — dlinnoaksonny neurocytes (neurocytus longiaxonicus — LNH) with short numerous dendrites (fig. 10) branching near a cellular body with one neurite which is going beyond a ganglion; cells of the II type — ravnootrostchaty neyrotsitg (neurocytus equisurculatus — LNH) — surpass the first in size and have smaller quantity of the low-branching shoots (fig. 11) among which it is difficult to distinguish a neurite (axon). Both the neurons specified type are especially characteristic of intramural nodes went. - kish. path. Cells of the I type are effector neurons on which preganglionic fibers terminate. Cells of the II type represent sensitive neurons of local visceral reflex arcs. There are cells of an intermediate position. Their dendrites do not leave limits of a ganglion. Assign them a part of associative neurons. Except the specified types, distinguish unipolar and diaxones.

Fig. 12. The synapse on a body of a nervous cell from an auricle of a cat — specified by shooters (coloring across Bilshovsky — Groce — to Lavrentyev)
Fig. 13. Two neurocytes from heart of a frog (sketched during lifetime): at the left — on a surface of neuron small light plaques of synapses are visible (1); on the right — the same cells after coloring methylene blue. Plaques of synapses (2) and thread of the pericellular device (3) are visible.
Fig. 14. Disintegration of synapses (1) on a neurocyte from a stomach of a cat after section of preganglionic fibers of a vagus nerve (coloring across Bilshovsky — Groce — to Lavrentyev).
Fig. 15. The recovered synapse (1) on a nervous cell of an upper cervical node of a cat. the 21st day after section of a cervical sympathetic trunk (kaudalny a node) — coloring across Bilshovsky — Groce — to Lavrentyev.

Communication of vegetative neurons, structure of synapses in gangliya

In vegetative gangliya is available three sorts of nerve fibrils: a) the preganglionic axons bringing impulses to cells of this node from the central effector neurons and forming with them synoptic connections; b) postganglionic fibers — axons of neurons of the same or adjacent cross-links which carry out impulses to the innervated fabrics; c) afferent sensitive fibers of cerebrospinal nodes or local — from cells of the II type which form the terminations in a stroma of a node or go as transit goods (G. E. Mikhaylov, B. I. Lavrentyev, N. G. Kolosov, etc.). It is much less preganglionic nerve fibrils coming to any ganglion, than nervous cells in this node; so, for an upper cervical node of the person this proportion is expressed as 1: 100. There are various structural devices for transfer of nervous impulses from one preganglionic fiber on group of neurons (dentritic nests, receptor platforms, protoplasmatic ways); the phenomenon of animation of preganglionic fibers allowing to transfer impulses from one fiber on a large number of neurons is known. The different quantity of synapses is characteristic of different neurons. On bodies of neurons extramural gangliyev single synapses (fig. 12) while their ground mass is distributed on dendrites are located.

Assume that, as well as in c. N of page, different nerve fibrils B. of N of page can terminate on one cell. Under a microscope windings of thin trailer departments of preganglionic nerve fibrils around p erik and ri it and dendrites which terminate in trailer buds — expansions iod in the capsule on a surface of neuron and shoots are visible. The similar structure of synoptic bonds called by morphologists the pericellular device was shown in an intravital state in nerve knots of amphibians (fig. 13). At irritation of preganglionic fibers electric current or at impact on drug physical. or chemical agents changes of threads of the pericellular device, enlargement of its trailer plaques are observed morfol. At section of preganglionic nerves in vegetative nodes disintegration of pericellular threads and trailer structures of synapses (fig. 14) is observed. In the course of reinnervation of a node the structure of the synoptic device, as well as its function, is recovered (fig. 15). In V. the N of page described also akso-axonal contacts which can be made both between terminalyam of two preganglionic fibers, and between axons of the central and peripheral neurons (V. P. Babmindro). In V. of N of page more often than in other parts of the nervous system, dendro-dendrichesky and dendro-somatic contacts meet. Can be their compound components as dendrites of the same neuron, and different neurons.

Elektronnomikroskopichesky researches open complex structure of synoptic connections: existence of presynaptic and postsynaptic membranes and synaptic gaps, and also the presynaptic and postsynaptic bubbles containing mediators. Histochemical researches find a large amount of reactive substances in vegetative neurons. According to their contents and localization judge functional features and conditions of vegetative neurons. Distribution in neurons and glial elements of sulphhydryl proteinaceous connections, various amino acids, RNA, DNA and other connections is described. From among enzymes of cytoplasm of vegetative neurons it is necessary to specify enzymes biol, oxidations; the large role in specific nervous activity of vegetative neurons is played by mediator substances — the catecholamines inherent in neurons of sympathetic nodes, and acetylcholine — a mediator of parasympathetic part V.n.s.

Vegetative conductors and their terminations in bodies

Fig. 16. Regeneration of a trailer texture of sympathetic nerve fibrils (1) in unstriated muscles of a stomach of a dog. the 3rd day after removal of a semi-lunar ganglion (coloring across Bilshovsky — Groce — to Lavrentyev).
Fig. 17. Regeneration of sympathetic nerve fibrils in a myocardium of an auricle of a cat (1). the 3rd day after removal of a star-shaped node (coloring across Bilshovsky — Groce — to Lavrentyev).
Fig. 18. Identification of sympathetic adrenergic nerve fibrils (in the form of white threads) in a myocardium of a cat by means of specific histochemical reaction (Falk's method).
Fig. 19. Identification of parasympathetic cholinergic nerve fibrils (in the form of black threads) in a myocardium of a cat by means of specific histochemical reaction (the Kelle method — Gomori).
Postganglionic axons of sympathetic and parasympathetic neurons in the innervated bodies form the amyelenic preterminal departments the textures consisting of so-called cable systems of nerve fibrils. They are presented by syncytial tyazha of oligodendrocytes in which protoplasm there can be axons of various anatomic and functional purpose: postganglionic sympathetic and parasympathetic conductors, and also trailer departments of afferent sensitive fibers. The structure of axons of these textures can be established by means of section of the corresponding conductors (fig. 16 and 17) and histochemical techniques (fig. 18 and 19).

There are also histochemical methods, is elective the revealing sympathetic and parasympathetic nerve fibrils and their terminations. Use by gistokhy. methods and a supermicroscope allowed to establish that sympathetic and parasympathetic nerve fibrils form in the innervated bodies and fabrics the terminal nervous structures, extensive, widespread on substrate, adapted for allocation of mediators and enzymes. Researches of the neurons which are a part vegetative gangliyev testify to their qualitative heterogeneity. By means of the same elective methods adrenergic nervous cells are found as a part of a muscular and intestinal texture of a duodenum, in textures of a colon, in intramural nodes of heart. At the same time among adrenergic neurons pre-and juxtaspinal sympathetic gangliyev also cholinergic and chromaffin cells are found.

Ekhinger and Falk's observations (V. of Echinger, V. Falk) who described adrenergic neurons as a part of a ciliary ganglion are interesting. Assume that in fiziol, conditions function of these neurons is carried out at so low level of metabolism of a mediator that histochemical it is not possible to find it.

Studying of an embryogenesis of some vertebrata and the person with tselyo establishments of terms of emergence of the main mediators allowed to define stages of their formation (V. N. Shvalev). Domediatorny a stage at embryos of the person falls on 5 — 8 weeks and is characterized by germination of nerve fibrils in tissue of internals. This period is significant lack of a mediator in the differentiated neurons. Distribution of a mediator on nervous conductors is carried out during the fetal period. At this stage («mediator») the adaptation and trophic integrating impact on the developing structures of bodies begins to be carried out: intensively receptor structures, synapses form, process of myelination begins.

The physiology

General physiology of Accusative of page studies both its functions in general, and characteristics of components, using methods of synthesis and the analysis. Synthetic approach has a task definition of the place of vegetative processes in functions of a complete organism. Still Ch. Darwin noticed that each subjective feeling (e.g., hunger, thirst, fear, rage) causes changes in work of internals.

By the beginning of 20 century big actual material about vegetative components of food and defensive instinctive reflexes is saved up. A part of these data formed the basis of methods of assessment of changes of vegetative indicators at the various functional trials which are widely applied in modern medical practice. The doctrine about conditioned reflexes opened one more direction in a research B. of N of page, having allowed to formulate synthetic representations about fiziol, value of vegetative components of conditional reactions, about the uslovnoreflektorny changes of breath, cordial activity and blood circulation accompanying any behavioural activity (P. K. Anokhin, 1956). Conditioned reflexes various biol, qualities differ also in the nature of vegetative changes, i.e. have a different «vegetative portrait» (V. A. Shidlovsky, 1960).

Using systems approach, P. K. Anokhin and his followers established that V. the N of page creates a vegetative part of efferent information, preparing and providing somatic action with the corresponding metabolic processes. In full accordance with these representations there are comparative and morphological data that somatic and V. N of page are essentially the identical parts of a nervous system which developed from identical devices, but undergone divergent evolution in an organism: somatic — together with eksteroretseptor and bodies of the movement, and V. of N of page — with interoretseptor and internals.

From positions of systems approach it is easy to explain the fact of the multi-level, hierarchical organization of the highest vegetative centers, distinctions of speed of carrying out in different groups of fibers B. of N of page and other data which are almost not interpreted within analytical approach.

Influence of the autonomic nervous system on vegetative functions is implemented by three main ways: through regional changes of a vascular tone, adaptation and trophic action and management of functions of internals, such as heart, went. - kish. path, spleen, adrenal glands, etc.

At electric irritation of sympathetic efferent cordial reductions amplify and their rhythm increases, the speed of carrying out excitement on a muscle of heart increases, arterial pressure increases, the content of glucose in blood increases, bronchial tubes, pupils extend, secretion of a medulla of adrenal glands increases, the tone decreases went. - kish. path. Stimulation of parasympathetic nerves reduces force and frequency of reductions of heart, slows down the speed of carrying out excitement on a myocardium, reduces arterial pressure, increases secretion of insulin and reduces concentration of glucose in blood, leads to strengthening of motor and secretory functions went. - kish. path (table). The result of irritation of autonomic nerves in many respects is defined by a condition of the innervated body and depends also at most and duration of stimulation. So, irritation of a vagus nerve against the background of sharp increase in a tone went. - kish. a path slows down motor function. Weak stimulation of the same nerve can strengthen cordial activity whereas the strong irritation of sympathetic fibers is capable to render on functions of heart the oppressing effect (M. G. Udelnov). These observations prove that antagonism between a sympathetic and parasympathetic nervous system has very conditional character.




Action on a vascular tone. Though the tone of unstriated muscles of a vascular wall is caused by hl. obr. local factors (G. P. Konradi, 1973), the irritation of nerve fibrils leads to its considerable changes. The fact of vasoconstriction at irritation of a sympathetic trunk is widely known. Vazodilatatorny action some parasympathetic fibers (a drum string and a sexual nerve), fibers from structure of back roots of a spinal cord and sympathetic nerves of vessels of heart and skeletal muscles possess. Their action is blocked by atropine. The changes of a blood-groove accompanying any behavioural activity and which are carried out through V. by N of page are implemented according to the following scheme: cordial activity amplifies, vessels of the functioning muscles while in other bodies and fabrics the compensatory vasoconstriction covering first of all internals, not active muscles, skin is observed extend.

Adaptation and trophic function. At the end of 19 century of hl. obr. by clinical observations it was established that after destruction of nerves in the bodies and fabrics innervated by them develop functional and morfol, disturbances which cornerstone frustration of a trophicity are.

Investigating trophic function of a nervous system, physiologists paid attention first of all to its sympathetic part. In classical experiences of A. G. Ginetsinsky (1923) it is shown that the skeletal muscle brought to exhaustion by long irritation of a motor nerve at stimulation of sympathetic fibers begins to answer with intensive reductions again. The phenomenon of ergotropny «removal of exhaustion» of a skeletal muscle additional irritation of a sympathetic nervous system received the name of a phenomenon of Orbeli — Ginetsinsky and became a basis of a big series of pilot studies. It was established that stimulation of a sympathetic trunk considerably reduces exhaustion only at transsynaptic activation and is not effective at all at direct electric irritation of a muscle. The irritation of sympathetic fibers in itself, though is not followed by external manifestations, significantly changes conductivity, a chronaxia, excitability, elastoviscous properties and speed of a number of chemical processes in skeletal muscles. The irritation of sympathetic nerves changes also other functions, napr, modifies electric properties of a cardiac muscle, skin, increases excitability of receptors and somatic nerves, changes the speed of a blood coagulation, activity of enzymes, leads to increase in glucose and free fatty acids In blood etc. Also influence of a sympathetic nervous system on c is proved. N of page, expressed in changes of its conditional and bezuslovnoreflektorny activity, and also bioelectric activity.

The received facts are generalized by L. A. Orbeli (1923) in the theory of adaptation and trophic influence of a sympathetic nervous system. According to this concept there are vegetative nervous influences which are directly not followed by visible action, but considerably changing functional reactivity or adaptation properties of fabric and also their biochemical and morfol, characteristics, i.e. trophic indicators.

It is proved that adaptation and trophic influences exist in addition to action on a vascular tone and changes of permeability and do not come down to activity only of a sympathetic nervous system. At the expense of this adaptation and trophic innervation which is carried out sympathetic, parasympathetic and partly by zadnekoreshkovy (sensitive) fibers conditions for jump of functional properties of peripheral receptors and neuromuscular devices, and also all are created to c. and. page. (Whether L. A. O swarm, 1945).

C. the N of page exerts the mediated adaptation and trophic impact on all organism through system neurosecretions (see), peripheral nervous system and endocrine device.

Adaptatsionnotrofichesky influence of motive fibers on skeletal muscles is very expressed. The law of denervation of U. Kennon (1939) says that sensitivity of denervated body to various influences nonspecific increases, thresholds decrease, and amplitude and duration of reactions increase.

The specific nerves having the isolated, purely adaptation and trophic effect are not found yet. It is implemented by all nerves in parallel with their main function. Therefore it is considered that adaptation and trophic influences are transferred not in the pulse, but neuro and humoral way, napr, due to action of the mediator which did not collapse in a synapse to the remote vnesinaptichesky receptors (V. A. Govyrin, 1967). Therefore, at the heart of adaptation and trophic action there can be a process of diffusion of an aksonny bombway of mediators and products of their exchange, and also nucleotides and products of metabolism of the nucleic acids synthesized in a kernel of a nervous cell.

Probably, in the mechanism of adaptation and trophic influence the essential role belongs to current of an axoplasm continuous proximal distally on nerve fibril with a speed apprx. 1 mm a day [P. Weiss, 1963]. The proteins, nucleotides and other biologically active agents diffusing further in effector bodies are delivered by this way to aksonny bombways. The mechanism of slow axonal transport explains also adaptation and trophic action of sensory nerves.

The peripheral department of the autonomic nervous system

During the studying of the mechanism of regulatory influences of V. of N of page is important analytical approach. His founder D. Langley in 1906 formulated the principle of chemical momentum transfer and established that a peripheral part of all vegetative ways is constructed of two consistently located neurons. Transfer from preganglionic neuron on postganglionic is carried out in extra-and intramural peripheral gangliya. Sympathetic fibers pass several peripheral gangliyev, switching in one of them where preganglionic aksonny bombways come to an end on a body of postganglionic neurons.

The two-neural structure of a peripheral effector part opening a possibility of intra ganglionic integration is characteristic of the general plan of a structure of V. of N of page and cardinally distinguishes it from a somatic nervous system.

As both postganglionic sympathetic and preganglionic parasympathetic fibers, influence of both parts B. of N of page on the innervated bodies variously approach bodies: the parasympathetic innervation is capable to carry out local powerful influences whereas sympathetic can involve in reaction several bodies and systems at once. Dispersion and animation of impulses in both cases are provided with branching pre-and postganglionic fibers, i.e. each preganglionic fiber reaches a limit on bodies of many postganglionic neurons. In turn on each postganglionic neuron also several preganglionic fibers terminate. The phenomenon of spatial summation of impulses is connected with it: the irritation of separate preganglionic fibers does not cause the answer in postganglionic fiber, and the synchronous irritation of several preganglionic fibers easily excites postganglionic neuron.

At irritation of preganglionic fibers also the phenomenon of temporary summation is known. Its essence that the single preganglionic impulse does not excite postganglionic neuron, however the answer arises at rhythmic preganglionic irritation. Normal under the influence of a preganglionic impulsation V.'s neurons of N of page are irritated with a frequency no more than 15 impulses of 1 sec. More frequency irritation of preganglionic fibers leads to a phenomenon of transformation of a rhythm. Stimulation over 100 times in 1 sec. considerably exceeds a threshold of a pessimum of frequency and leads to the full block of carrying out excitement through a ganglion.

Usually in V.'s gangliya of N of page of postganglionic neurons several times it is more, than preganglionic fibers. Diam, the last from 1 to 3,5 micron, and postganglionic — 1 — 2,5 micron. Speed of carrying out impulses in postganglionic fibers is lower, than in preganglionic, and makes apprx. 1 m/s, in preganglionic fibers of a parasympathetic nervous system it reaches 10 — 20 m/s, and sympathetic — 1,5 — 4 m/s.

Transfer of excitement from preganglionic neurons on postganglionic is carried out only through synapses (see. Synapse ) by means of biologically active agents — mediators (see). And by transfer of excitement from the second parasympathetic neurons on the innervated fabric acts as the main mediator in V.'s gangliya of N of page acetylcholine (see). In 1933 Dale on the basis of the rule about identity of the mediators allocated by all terminalyam of this neuron suggested to call nervous cells and fibers on the mediator allocated their terminalyam. According to this nomenclature all parasympathetic neurons and preganglionic sympathetic neurons will be cholinergic, and postganglionic sympathetic — adrenergic. In cholinergic the term the Pole of 60% of acetylcholine is in granules in the form of 0,15 M of isotonic solution. Under the influence of nervous impulse acetylcholine is released and leaves in a synaptic gap where partially at once, and partially after reaction with protein receptor it is hydrolyzed by cholinesterase on sincaline and acetate.

Electrically the unexcitable subsynaptic membrane of each synapse contains apprx. 3*10^6 atsetilkholinochuvstvitelny receptors. Their chemical structure is not known, but indirect methods determined a stereochemical configuration for M (muskarinochuvstvitelny) and H (nicotinosensitive) receptors. Earlier was considered that M-holinreaktivnostyo only synapses in the terminations of parasympathetic postganglionic neurons are characterized, and H-cholinereactive structures are available in sympathetic and parasympathetic ganglions, a carotid body, neuromuscular synapses and c. N of page.

It is nowadays established that M-holinoretseptory are also in a sympathetic ganglion. It is possible that phylogenetic more ancient M-holinoretseptory are capable to change sensitivity N-holinoretseptorov. Similarly, slowing down transfer in sympathetic gangliya, also adrenaline affects adrenoceptors of chromaffin intra ganglionic cells. Adrenergic fibers are found in an abdominal brain and the lower mesenteric ganglion.

Fiziol, and morfol, data confirm existence in a stroma vegetative gangliyev the receptor educations which are constantly informing c. and. page about metabolic changes.

According to I. A. Bulygin (1959) data, M. G. Udelnova (1961) there are reflexes which first neuron is the visceral offerer — a cell of the II type across Dogel, and efferent — visceral postganglionic neuron. Besides, at irritation of fibers B. and. the page can be observed axon reflexes (see) or the pseudo-reflexes differing in the fact that at their short circuit there is no switching of excitement from a receptor neuron on effector. For implementation an axon reflex it is necessary to irritate an axon of such vegetative neuron, one branch to-rogo one body or its part innervates, and the second — other body go other its part. In this case reaction can be found at considerable distance from a point of stimulation.

Trailer devices of vegetative nervous system. Morfol, by works it is established that not each cell of internals receives a vegetative innervation. In particular, smooth muscle fibers of a wall of vessels of skeletal muscles have no sympathetic efferent. Their synoptic bombways are on border between outside and average covers of vessels. However the sympathetic innervation with success provides vasomotion. For an explanation of these phenomena At. Kennon and Rozenblyut (A. Rosenblueth, 1937) assumed that the innervated «key» cells which are allocated at action on widely diffuse mediators and influence the next, not innervated groups of cells. V. A. Govyrin (1967) finds possible diffusion of monoamines the mechanism of adaptation and trophic influences. This representation is supported with existence of adrenoceptors in a postsinaitichesky membrane of N-cholinereactive somatomotor synapses. Their existence explains the fact that stimulation of a sympathetic nerve removes the exhaustion of a skeletal muscle caused by indirect irritation, but is not capable to exert impact on the exhaustion caused by direct irritation. So is confirmed that action of a vegetative innervation can be implemented by a neuro and humoral way due to diffusion of a mediator.

As a result fiziol, Hillarp's experiments (N. A. Hillarp, 1960) and elektronnomikroskopichesky observations it is revealed that sympathetic postganglionic neurons supply functional units of effector cells not only trailer presynaptic devices, but also form a set of synapses «on the course». The quantity of presynaptic varicosity «on the course» reaches 15 — 30 on 100 microns of length of a bombway and increases in process of reduction of its diameter. In varicosity accumulation of vesicles which on the morfol, and fiziol, to properties do not differ from vesicles of other synoptic structures is revealed. By method of fluorescence it is revealed that bodies of nervous cells and a non-terminal part of axons contain from 10 to 100 mkg of noradrenaline on 1 g of fabric, and presynaptic bombways — to 10 000 mkg on 1 g. In experiences with irritation of sympathetic nerves of an iris of the eye the direct evidence of release of noradrenaline from varicosity of presynaptic bombways is obtained.

Transfer of excitement from all sympathetic nerves on effector bodies is carried out by mediators of a katekholaminovy row: adrenaline and more noradrenaline. In presynaptic terminalyakh catecholamines are deposited in special vesicles or synoptic bubbles. Bubbles are divided by the sizes on big and small. The last granulyarna also contain bigger quantity of noradrenaline. It is considered that catecholamines are synthesized in a body of a nervous cell, pass into structure of cytoplasmatic granules and in this form are slowly transported on an axon in the direction of trailer branchings. Besides, synoptic bombways intensively absorb catecholamines from blood and liquid of extracellular space. In terminalyakh noradrenaline exists in two pools (depot): small, labile, easily releasing substance under the influence of nervous impulse, and big, stable, strongly connected with protein. In cytoplasm monoamines quickly collapse enzyme monoamine oxidase (see). It is long monoamines can remain only in granules. ATP and ions of Mg are necessary for the mechanism of the transfer of catecholamines from cytoplasm in granules blocked, e.g., by Reserpinum and Isobarinum +2 . In response to nervous impulse a nek-swarm the amount of monoamines of a labile pool is released from granules in cytoplasm where it is partially deaminized by monoamine oxidase, and partially comes out in a synaptic gap. Here too nek-paradise a part of a mediator collapses enzyme catechol-methyltransferase, another — reabsorbirutsya aksonny a bombway, and the third, the most important, participates in transfer of nervous impulse, coming into contact with proteins receptors of a postsynaptic membrane and changing their conformational properties. Distinguish α-and β-adrenoceptors.......... Action of catecholamines on the first reduces, and — increases by the second [the mechanism is blocked by nek-ry prostaglandins (see)] activity of enzyme of the adenyl cyclase catalyzing education from ATP cyclic 3', 5 '-adenosinemonophosphate (tsAMF). The last activates a protein kinase that in turn leads to growth of concentration of phosphoproteins in a membrane with the subsequent increase in its ion permeability. Theophylline blocks the enzyme phosphodiesterase inactivating tsAMF. The ratio of trailer devices of sympathetic and parasympathetic parts B. of N of page at an innervation of intestines is unusual. Rare bombways of adrenergic nerves are found hl. obr. around cells of a subserosal texture. In them, but not in terminalyakh on a muscular layer of intestines exogenous noradrenaline, marked hyzone comes to light. Brake influence of a sympathetic nervous system on motility went. - kish. a path is explained by the fact that the postganglionic sympathetic neuron terminates in akso-axonal and akso-somatic synapses on cells and terminalyakh postganglionic parasympathetic neurons and activity oppresses them.

The central department of the autonomic nervous system

In sympathetic thoracolumbar and in the parasympathetic centers of an average and myelencephalon, sacral department of a spinal cord in final central efferent neurons directly or through internuncial neurons is converged by signals from spinal somatic offerers, visceral offerers, both the spinal, and intramural, passing hl. obr. as a part of the wandering, celiac and pelvic nerves of the next segments of a spinal cord, and from the highest vegetative centers. This or that character of efferent impulses will be determined by the vegetative fibers which are coming out a brain by spatio-temporal characteristics of the influences converging on final vegetative neurons.

Excitement of visceral offerers in any segment of a spinal cord can be transferred not only on vegetative, but also to somatic final efferent neurons. The strong irritation of visceral offerers leads to emergence in motor-neurons of a spinal cord of the local, but extending excited postsynaptic potentials (see. Visceral reflexes ).

Through a reticular formation of a mesencephalon the supraspinal reflex leading to selective excitement of neurons of sgibatel and braking of razgibatel that is followed by coordinate motive acts becomes isolated. On the basis of these mechanisms in pathological cases the powerful impulsation from visceral receptors can lead to emergence of visceromotor and viscerosensory reflexes (a muscle tension, forced poses, disorders of sensitivity, etc.).

The highest vegetative centers. At the end of 19 century considerable discoveries in the field of physiology of the highest vegetative centers were made: the sugar prick of K. Bernard (1849) in a bottom of the IV ventricle which is followed by increase in sugar in blood, opening (1871) vasomotor centers by V. F. Ovsyannikov in the same area, V. Ya. Danilevsky's researches (1874) about changes of blood circulation at irritation of bark of big cerebral hemispheres. The foundation of system ideas of the highest vegetative centers was laid by Drezel (To. Dresel, 1924). He suggested to characterize their activities for action on a certain vegetative function of all organism. In this regard ideas of the centers carbohydrate, fatty, in a one-salt metabolism, thermal control, blood circulation, breath etc. were created. The subsequent studying of the highest vegetative centers showed that they are organized by the hierarchical principle. In regulation of many vegetative constants it is possible to allocate at least two fiziol, level. The first of them possesses relative autonomy and carries out regulation of a vegetative homeostasis in the usual conditions which are characterized a nek-eye by constancy, napr in a dream, at rest. The second Integra of a tion in the changing conditions of the environment during the ensuring motive, motivational and emotional activity solves a problem somato-vegetative. The centers of the first level are located hl. obr. in a myelencephalon and podbugorny area. The centers of more high level solve a problem of adaptation of vegetative reactions to somatic activity. Their irritation leads not to development of the isolated reactions, and is always implemented in difficult vegeto-somatic manifestations. Here «vegetative» function becomes only a component extensive somato-vegetative fiziol, integration. Therefore the neurons concerning regulation, napr, breath, it is possible to find at all levels of c. N of page. Irritation practically any area of c. the N of page leads to these or those vegetative shifts, and than the irritated site phylogenetic is younger, that character and an orientation of vegetative changes are less natural. Researchers actually refused searches of the highest sympathetic and parasympathetic nerve centers as it is not possible to differentiate functions of both parts B. of N of page at the level of the highest centers. Moreover, «... climbing above the central nervous system... we meet that "vegetativnost" more and more escapes the researcher, and eventually we face integrative processes of bark of big hemispheres where the question of vegetative accessory of this or that nervous element becomes already doubtful and unreal» (P. K. Anokhin, 1958). Extreme importance of somato-vegetative integration is obvious in implementation such fiziol. acts, as cough, vomiting, crying, urination, coitus, defecation, breath, food etc. Implementation of these functions due to activity only vegetative or only a somatic nervous system is essentially impossible. Constant need of somato-vegetative integration dictated absolutely certain way of development of the highest vegetative centers. Complication of locomotory function of vertebrata and development of nadsegmentarny devices led to the organization of representations of vegetative functions in a trunk and a cerebellum. The emergence of affective and motivational behavior which was followed by development of a mesencephalon would cause further improvement of the vegetative centers a hypothalamus and in structures of limbic system. H and the end, improvement of distantny analyzers and development of the highest forms of behavior demanded existence of vegetative representations in a neoncephalon and in bark of big hemispheres.

K. M. Bykov's works proved a possibility of formation of conditioned reflexes in response to irritation of internals. Electrophysiologic researches B. N. Chernihiv, R. A. Durinyana, K. M. Kullanda showed that in the organization of specific cortical projections of visceral and somatic offerers there are no basic distinctions. As well as somatic, autonomic nerves are projected on several areas of a cerebral cortex: e.g., the vagus nerve has three projective areas, celiac and pelvic nerves — two, and in the same areas on the same neurons also somatic offerers terminate. Extensive overlappings of projective zones are found also at the level of a specific back and lower kernel of a thalamus.

Somatic offerers activate the bigger amount of neurons is considerable, than vegetative, besides, somatic signals are capable to block answers of thalamic neurons to visceral irritations. It is possible that normal visceral sensitivity does not reach consciousness since is suppressed with more powerful flow of a somatic afferentation (R. A. Durinyan, 1965). At strong irritations of visceral offerers, stimulation of amygdaloid kernels, a hypothalamus and other highest vegetative centers in a thalamus and bark of big hemispheres the phenomenon of spatio-temporal summation is observed. As a result considerably the amount of the thalamic and cortical neurons answering with excitement the visceral alarm system increases.

Pathological anatomy

Early studies belong to the second half of 19 century, they are executed by the Russian scientists V. A. Zhdanov (1885), H. M. Popov (1886), S. N. Uspensky (1896), etc., described a gist. changes in sympathetic nodes and intramural gangliya of heart at intoxications.

At influence ekzo-and internal disease-producing causes in V.'s morphology and. pages occur stereotypic nonspecific changes. These changes are described and their classification in neurohistology by Shpilmeyer (W. Spielmeyer, 1922), Jacob (A. Jakob, 1927), D. I. Smirnov (1941), P. E is given. Snesarev (1950), Yu. M. Zhabotinsky (1953), A. I. Strukov and S. K. Lapin (1956), H. E. Yarygin and V. N. Yarygin (1973).

Fig. 20. Upper cervical sympathetic node. A large cell (it is specified by an arrow) with signs of swelling, a chromatolysis and a karioliz (coloring across Nissl; X 400).
Fig. 21. Chest sympathetic node. Granular glybchaty disintegration of nerve fibrils — is specified by shooters (impregnation by silver by Campos's method; X 400).
Fig. 22. Star-shaped node. Sclerosis of a stroma of a ganglion. The single remained nervous cells — are specified by shooters (coloring hematoxylin-eosine; X 100).
Fig. 23. Lumbar sympathetic node. The hypertrophied two-nuclear neuron — is specified by an arrow (impregnation by silver by Campos's method; X 400).

The most often meeting morfol, changes of neurons are: a partial or total chromatolysis of basphilic substance, swelling, vacuolation, fatty dystrophy of cytoplasm, karioliz, pycnosis, a pigmental atrophy of a neurocyton, a neyronofagiya, varicose changes, vacuolation, demyelination, zernisto - glybchaty disintegration of nervous conductors, nodulation from satellites, growth of connecting fabric in a stroma gangliyev (fig. 20 — 22).

A number of diseases (e.g., a sapropyra, rage) can be followed by characteristic changes in V. and. page.

Use in a complex of neurohistologic, histochemical and gistoenzimatichesky methods of a research allowed to prove the principles and initial positions of studying of a patomorfologiya of V. of N of page 1. Age changes shall be considered. Dystrophic changes and death of single neurons, accumulation of a pigment in cytoplasm of nervous cells, a hypertrophy of bodies of separate neurons, emergence of two-nuclear nervous cells (fig. 23), growth of dendrites, increase in quantity of a stroma in gangliya, formation of separate small knots from satellites constantly are found in healthy people of various age. 2. It is necessary to know features of a structure sympathetic and parasympathetic ganglions. So, a characteristic sign sympathetic gangliyev usually is existence of a pigment in a neurocyton, two-nuclear nervous cells, abundance of a stroma. In the conditions of pathology the pigment is defined in a neurocyton of 200 and parasympathetic and sympathetic nodes. Two-nuclear nervous cells are less characteristic of parasympathetic ganglions, and the abundance of a stroma in them demonstrates pathological process. 3. It is known that morfol, changes of neurons in certain gangliya are depending on localization of the disease-producing center in this or that body therefore simultaneous studying of various links of a reflex way is necessary. 4. Lack of compliance between morfol, changes in V. of N of page and clinical manifestations of vegetative frustration. According to A. I. Abrikosova (1922), B. N. Mogilnitsky (1922), I. I. Shirokogorova (1923), found them a gist. changes in sympathetic gangliya are the cornerstone of those vascular reactions and clinical symptoms which are observed at infectious diseases. Along with it numerous patomorfo l. the changes in peripheral nerve knots described by M. A. Skvortsov (1946) at children, do not find the clinical reflection. 5. Assessment of degree morfol is important. changes in V. of N of page. A row them in peripheral nerve knots represents reversible shifts and is morfol, an equivalent of functional conditions of neuron. Usually it is metabolic, euzymatic, gistokhy. and gist. the shifts in structure of neurons arising in response to adequate irritations. Along with it the dystrophic, atrophic and necrotic changes of neurons which are followed by dysfunction of nervous cells meet. It is also necessary to consider that in gangliya V.n.s. both at healthy faces, and constantly are found in the people who died from diseases morfol. the changes of neurons having the nature of reparative processes (a hypertrophy of a neurocyton, increase in number of kernels and kernels, regeneration of shoots of neurons, formation of new interneyronalny bonds, etc.). These changes are expression of compensatory adaptations or pathological regeneration and are directed to completion of function of the died nervous cells. 6. Preganglionic fibers at infectious and other somatopathies are surprised earlier and more than postganglionic.

At infectious diseases in nerve knots of peripheral V. of N of page inflammatory changes with the expressed vascular reaction — staza, hemorrhages, thrombosis, availability of infiltrates, activators, abscesses in their stroma are described. Inflammatory changes of surrounding fabrics can sometimes pass on a ganglion. In sympathetic gangliya at a sapropyra there are characteristic changes of vessels in the form of a proliferative and destructive endothrombovasculitis with perivascular hemorrhages and infiltrates from the lymphoid, plasmatic and glial cells creating specific granulomas. The whole bunches of nerve fibrils are involved in process. Changes of neurons prevail over damage of a stroma of sympathetic nodes. A. I. Abrikosov (1922) in work «Pathological anatomy sympathetic gangliyev» showed that along with pathological changes of neurons circulatory disturbances — fibrinferments, hemorrhages, change of a wall of vessels are constantly observed. Often infiltrates, sometimes with formation of abscess are found.

At belly and returnable typhus, in addition to dystrophic changes of nervous cells and their shoots, in a stroma sympathetic gangliyev lymphoid infiltrates constantly are defined. At such infections as diphtheria, scarlet fever, cholera, plague, rage, multiple heavy necrobiotic changes of neurons are observed.

The macroscopic type of nerve knots at infectious diseases also changes. If at a lung fever they look bulked up, flabby, increased, with hemorrhages in their stroma, then miliary tuberculosis is followed by noticeable reduction and consolidation gangliyev.

V. defined a topic of defeats of N of page, and sometimes and type of changes of nervous cells is characteristic of the majority of infectious diseases. So, at pneumonia destruction of the cells found in upper cervical part of a sympathetic trunk has group character.

Flu is followed by the diffusion destructive process which is expressed in a total chromatolysis of basphilic substance, dissolution or disintegration of a kernel and wrinkling of a neurocyton. Intensity and a topic of defeats of a sympathetic nervous system at tuberculosis depend on its form and preferential localization of pathological process. Acute forms of tuberculosis are followed by uniform distribution of dystrophic changes of neurons in many gangliya of a sympathetic trunk. At it is long the current forms of tuberculosis reduction of number of neurons and growth of a stroma gangliyev is observed. These changes are defined preferential in cervical and chest sympathetic nodes. At tuberculosis of intestines neurons of nodes of an abdominal brain are surprised more. Selective defeat of intramural nodes of intestines at dysentery was found by V. P. Kurkovsky (1939).

At some other diseases changes in various departments V.n.s were also widely studied. M. I. Avdeev et al. (1935) investigated upper cervical and star-shaped a ganglion in cases of sudden death at cardiovascular insufficiency and found in them pycnosis, vacuolation, excess lipofustsinny pigmentation of neurons, fragmentation of nerve fibrils with formation of spherical thickenings, growth of the dendrites creating balls, increase in amount of connecting fabric in gangliya. At an idiopathic hypertensia data on changes in extra-and intramural nodes of heart, and also in nodes of an abdominal brain are contradictory.

At atherosclerosis it is noted that, in addition to changes of neurons, in sympathetic gangliya and intramural nerve knots of heart sclerous changes of their vessels are defined. These changes can matter in a morphogenesis of dystrophic processes in neurons which perish, and in gangliya connecting fabric expands.

In various phases of development of rheumatism of change of neurons can be either reversible, or dystrophic and regenerator, or combined. In nervous gangliya and covers of nervous conductors at rheumatism constantly are defined a gist. and gistokhy. changes of a mesenchyma. Patomorfologiya of a mesenchyma gangliyev is expressed at the same time in emergence beta and gamma metachromasias, change of tinktorialny properties of collagenic fibers, a sclerosis and a hyalinosis of a stroma of nodes; all this is result of mucoid and fibrinoid changes of connecting fabric gangliyev.

At the long septic endocarditis developing against the background of rheumatism in peripheral nerve knots also the changes inherent to rheumatism, and the changes inherent in sepsis lenta are defined. In a gleam of vessels gangliyev bacterial are defined; emboluses, arise inflammatory infiltrates with existence of leukocytes and formation of microabscesses.

In cases hron, colitis, without tendency of ulcers to healing, in nodes of an abdominal brain and lumbar department of a sympathetic trunk profound dystrophic changes of neurons which are followed kariolizy, a karyorrhexis and disintegration of nervous cells with their transformation into a detritis are defined. Nervous conductors at the same time are exposed to varicose changes and fragmentation. Considerable changes intramural gangliyev intestines and neurons of an abdominal brain are described at cancer. Consider that morfol, V.'s changes and. pages at infectious and other somatopathies, as a rule, are secondary.

V.'s changes are various and. page at poisonings and intoxications. A. I. Abrikosov (1922) emphasizes that heavy necrobiotic and necrotic changes of neurons sympathetic gangliyev are characteristic of poisonings. So, in an experiment with lead poisoning in an upper cervical, star-shaped node and in gangliya of an abdominal brain there are pycnosis of a kernel of N of cells, karioliz, a homogenization or vacuolation of cytoplasm, pasting of neurofibrilla and other necrobiotic changes of neurons. At poisonings of people with methyl alcohol nervous cells sympathetic gangliyev, nodes of solar, submucosal and intermuscular textures and some other peripheral nerve knots are exposed to deep damages with change of neurofibrilla, disintegration of a neurocyton and fragmentation of shoots. Oppression of proliferative reaction of satellites is noted.

Morfol, V.'s changes N of page occur also at radiation defeats. At height of development of a radial illness in peripheral departments of Accusative of page massive hemorrhages constantly meet.

On experimental works of V. V. Kupriyanov it is known that a part of the receptor device of a myocardium at a radial illness perishes. According to V. V. Portugalov, activity of enzymes in receptors and nervous conductors decreases, and in synapses increases. Neurons of a sympathetic trunk and intramural nerve knots of heart, intestines and other bodies at the beginning of a radial illness are exposed to reversible reactive changes which at height of a disease gain character of destructive. Administration of radioactive strontium ( 89 Sr) an animal causes in nervous cells vegetative gangliyev the phenomena of a gnezdny or widespread chromatolysis, reduction of a kernel and proliferation of glial elements. In later terms (3 — 6 weeks) there is a wrinkling and death of neurons, receptors of various bodies, fragmentation of nervous conductors. Similar patterns come to light also at administration of polonium. Gistoavtoradiografichesky researches showed that neurons of sympathetic nodes change more, than nervous cells sensitive gangliyev. Action of radiation on peripheral V.'s structures of N of page at local radiations comes to light after use of high doses, through a considerable time term and can be expressed in manifestation of necrobiotic and necrotic changes of neurons.

Primary tumors of peripheral V. of N of page develop from nerve fibrils and their covers more often. Here belong neurinoma (see), neurofibroma (see) and malignant neurinoma. The benign tumor constructed generally of ganglionic cells meets rather seldom, preferential in sympathetic gangliya, and is designated as ganglioneuroma (see). Its malignant analog — neuroblastoma (see) — develops in a sympathetic trunk.

From the central departments of V. of N of page side horns of a spinal cord, a medulla, hypothalamic area, a cerebellum, subcrustal nodes, the cortical vegetative centers are surprised more often. Defeat of vegetative kernels of side horns of a spinal cord meets at rage, syphilis, tuberculosis, dysentery, etc.

Fig. 24. Neurons of a spinal cord at an idiopathic hypertensia: and — well remained neurons of front horns of a spinal cord — are specified by shooters (coloring across Nissl; x 200); — swelling of neurons of a side horn of a spinal cord (are specified by shooters), their chromatolysis (coloring across Nissl; X 400).
Fig. 25. Fresh hemorrhage in a spinal cord (it is specified by an arrow) with destruction of its substance at an idiopathic hypertensia (coloring hematoxylin-eosine; X 100).

It is known that defeat of neurons of side horns in comparison with nervous cells of a brain and peripheral nerve knots has more difficult character. E.g., at an idiopathic hypertensia the changes of neurons which are followed by their swelling, partial more rare a total chromatolysis, kariotsitolizy, sometimes hemorrhages (fig. 24 and 25) are found.

At poisoning with nek-ry organic and inorganic compounds there are deep destructive processes also in neurons of side horns of a spinal cord. The disturbances of intracellular exchange revealed by histochemical reactions are the cornerstone of these changes. The considerable changes of nervous structures of hypothalamic area which sometimes are combined with vascular frustration at impact on an organism of tetraethyllead, mercury, manganese, compounds of nickel, phosgene, arsenous connection, carbon monoxide, hydrocianic to - you, methyl alcohol, antifreezes, aniline are found. Histochemical changes at the same time are expressed in reduction of RNA and DNA in neurons. Poisonings with carbon monoxide, hydrocianic to - that often are followed by education in hypothalamic area of the centers of a softening.

Diseases of the autonomic nervous system

Distinguish V.'s diseases of N of page caused by defeat of its various departments and various vegetative frustration owing to pathological processes in c. N of page, and also at diseases of internals and fabrics (e.g., at general diseases of connecting fabric, diseases of blood, etc.).

Classification

Uniform classification of diseases of V. and. there is no page. Various principles are the cornerstone of them. So, Müller (L. Century of Muller, 1924), Kuntts (A. Kuntz, 1953) suggested to classify them by separate bodies, systems and processes. G. I. Markelov (1948) presented anatomo-fiziol. scheme. I. I. Rusetsky (1958) allocated three groups of vegetative syndromes depending on organic, functional lesions of a nervous system and diseases of bodies. More difficult classification is created by I. S. Chetverikov (1968). A. M. Grinstein and N. A. Popova (1971) allocate three groups of diseases of V. of N of page on other principles: 1) diseases of bodies and fabrics owing to organic lesions of V. of N of page at all its levels; 2) vegetopatiya; 3) vegetative neuroses. The general for all classifications is: recognition of lack of sharp border the maenad organic processes in V. of N by the village and vegetative neurosises, various a topic of defeats of V. of N of page — bark, a hypothalamus, a spinal cord, the periphery, and also the accounting of those bodies and systems which preferential suffered owing to dysfunctions of V. of N of page

the Aetiology

the Factors causing organic lesions of V. of N of page can be tumors, infectious diseases, various poisonings, brain injuries. Disturbances of functions B. of N of page develop also at diseases of hemadens — a hypophysis, adrenal glands, sexual, etc. Acute joint rheumatism is capable to cause to both central, and peripheral V.'s damage of N of page. Vegetative syndromes at cervical and lumbar osteochondrosis (Ya. Yu. Popelyansky) are described.

Symptomatology

different departments of V. of N of page — from a cerebral cortex to nerve terminations in bodies and fabrics Can be surprised. So, diphtheritic toxin makes preferential impact on cells of the fibers of a vagus nerve innervating heart; at dysentery hl suffer. obr. sympathetic devices of an abdominal cavity and a sympathetic trunk from Th10 to L2. At poisonings with insecticides quite often there are vegetative frustration with a syndrome of a polyneuritis. At a vibration disease both vegetative and vascular frustration are observed. The closed injury of a brain often is followed by disturbances of functions of bark and a hypothalamus.

At pathological process in any site B. of N of page symptoms of a disease come to light not only in the structures which are directly connected with Topeka of process but also in the sites remote from the center. These phenomena of repercussion were described by A. Thomas, M. I. Astvatsaturov, M. B. Crolles, G. I. Markelov, etc.

The majority of the pathological phenomena in V. of N of page is caused by increase in excitability of its central and peripheral parts.

One of features of defeats of V. of N of page is frequent frequency and a paroksizmalnost of disease processes, and also diffusion of displays of pathology of V. of N of page that considerably complicates topical diagnosis of process.

Opposition of adrenergic and cholinergic parts B. of N of page in clinic was not repaid though a nek-swarm dominance of one of them can undoubtedly take place; to a vagotonia carry urticaria, bronchial asthma, a Quincke's edema, and to a sympathicotonia — a Raynaud's disease, migraine, a number of cardiovascular crises at hypothalamic syndrome (see).

At increase in a tone of both parts speak about an amphotonia, «pure» vagotonias and sympathicotonias are observed seldom. More often at the same patient from one bodies signs of a vagotonia, and others — a sympathicotonia prevail (e.g., bradycardia and a white dermographism, tachycardia and locks etc.).

Various defeats of a parasympathetic nervous system are shown by strengthening of sweating, narrowing of pupils, bradycardia, a respiratory arrhythmia, a red dermographism and strengthening of a vermicular movement of guts; sympathetic — expansion of pupils, locks, tachycardia, increase in blood pressure and a white dermographism.

The pathological centers both in central, and in a peripheral nervous system can cause disturbances of somatic and vegetative functions that is a component of semiotics of each organic lesion of a nervous system. Quite often vegetative semiotics happens the earliest display of diseases of a nervous system (A. M. Grinstein).

Fig. 26. Hypostasis of the left brush at a left-side hemiparesis after thrombosis of the right average brain artery (the right brush without changes).

At defeats of sensomotor and pretsentralny areas of a cerebral cortex along with paresis and paralyzes clear vegetative disturbances of skin (fig. 26), hypodermic cellulose and bones while disturbances of functions of internals are expressed poorly take place. On the contrary, at defeat of the basis and medial surface of a temporal share, bark of the basis of a frontal lobe, a zone crinkle and parasagittal area disturbances of functions of separate internals (heart, respiratory organs) are observed and almost the innervation of skin, hypodermic cellulose and bones is not broken. At the centers in verkhnetemenny area of bark muscular atrophies (the central origin) in the paralyzed extremities are observed.

At defeats of bark asymmetric fluctuations of skin temperature, blood pressure and quantity of leukocytes in blood of the healthy and paralyzed extremities are also observed; at defeat of back parasagittal area there can be frustration of an urination.

At defeat of a hypothalamus such difficult functions as breath, blood circulation, activity are broken went. - kish. path, thermal control, metabolism, emotions, dream and wakefulness.

Pathological processes in a brainstem, especially in a myelencephalon, its tire and a reticular formation can be followed by heavy disturbances of breath. The vasculomotor innervation suffers, action of the heart owing to defeat of kernels of vagus nerves is especially hard broken. Disturbances of a vegetative innervation of skin and hypodermic cellulose are to a lesser extent expressed.

At damages of a spinal cord disturbances of activity of V. of N of page of various character, especially trophic, vasculomotor, pilomotor frustration, sweating, functions of bodies of a small pelvis and internals are observed.

These frustration depend on the level of defeat, on the nature of process in a spinal cord (infections, a tumor, an injury, dystrophic processes etc.), on extent of defeat of the segmented device and conduction paths.

For clinic of spinal vegetative frustration disturbances of sweating, skin temperature, disappearance of a pilomotor reflex and reflex dermographism in body parts below the center of defeat at a cross break of a spinal cord have special value.

Bernard's syndrome — Horner is characteristic of defeat of cervical department of a spinal cord (see. Bernard-Horner syndrome ) with a triad of symptoms — a ptosis of an upper eyelid, an enophthalmos and narrowing of a pupil on the party of damage of a spinal cord.

The rich symptomatology is observed at defeat of chest department of a spinal cord: attacks of pains in heart with tachycardia or bradycardia, congestive processes in lungs, the phenomena of an acute abdomen, disturbance of functions of a liver, a stomach and other internals. At a myelosyringosis heavy trophic disorders of vegetovascular character are noted. At injuries of this department the hiccups, a meteorism, quite often paralytic impassability of intestines, falling of blood pressure, bradycardia is observed.

Defeats of lumbar department of a spinal cord lead to trophic frustration in the form of decubituses, to disturbances of functions of pelvic and generative organs.

Defeats of a boundary sympathetic trunk and its nodes give vegetative symptomatology (see. Ganglionitis ), and also inflammatory processes in cells and fibers of an abdominal brain (see. Solar plexitis ).

The special attention is deserved by vegetative frustration at diseases and injuries of peripheral nerves. At the same time in a zone of an innervation vasculomotor disorders, disturbances of sweating, a cold snap of brushes and feet, trophic disorders of muscles of skin, hypodermic fabrics (e.g., one half of the face), nails, formation of trophic ulcers, osteoporosis of bones of extremities are observed, etc. G. I. Markelov (1948) described mononeurites, polyneurites and radiculitises with symptoms of preferential defeat of vegetative fibers; he calls these cases vegetative neuritis (see) and polyneurites.

The symptom of Levi which is in bystry expansion of pupils under the influence of adrenaline that always speaks about a hyperexcitability of sympathetic part B. of N of page is known.

Among symptom complexes special value has the description Kassirer (R. Cassirer, 1868 — 1925) akroasfiksiya of an unknown etiology with the phenomena angiotrofonevroza (see) and dominance of cyanosis of extremities.

Also zadnesheyny syndrome — the syndrome of a vertebral artery or nerve for the first time described by Barret and Lyeu is known (J. And. Barre, 1925; Lieou, 1928). Ya. Yu. Popelyansky in 1961 — 1966 in detail studied this syndrome which is shown a headache of a certain localization and character, vestibular frustration and pains in heart, sometimes decrease in hearing and a vision disorder. The syndrome is observed at cervical osteochondrosis, is connected with microtraumatization of a sympathetic texture unkovertebralny growths and joint shoots at their incomplete dislocation (see. Barret-Lyeu syndrome ).

Nek-roye Froman's syndrome — Vegelina matters. It is observed at women at the age of 30 — 60 years and it is connected with a hyperexcitability of sympathetic part B. of N of page. It is shown by feelings of blow by electric current, burning, numbness, crawling of goosebumps, sometimes morbidity of joints, is more often at night and depending on position of hands. Disappears after massage and is not followed by vasculomotor frustration.

Methods of clinical trial

Methods of clinical trial can be divided into the following groups: 1) cardiovascular tests; 2) elektrofiziol, tests; 3) determination of content of biologically active agents; 4) other vegetative tests.

Carry to cardiovascular tests: research dermographism (see), kapillyaroskopiya (see), reaction of skin to the dosed uv radiation, adrenalinic and histamine skin tests, an oculocardiac Aschner's reflex — Danyini (see. Oculocardiac reflex ), Chermak's reflex, a clinostatic reflex of Daniyelopolu and an orthostatic reflex of Prevel (see. Vegetative reflexes ), hydrophilic test (see. Mac-Klyura-Oldricha test ), oscillography (see) and pletizmografiya (see), determination of skin temperature.

Elektrofiziol, tests — a research of electroskin resistance. Among methods of the third group — definition of catecholamines (adrenaline, noradrenaline, serotonin, etc.) in urine and blood, definition of activity of cholinesterase of blood.

Use also a research of sweating, sensitivity of zones of Zakharyin — Geda and a pilomotor reflex. The given techniques can indicate local or general disturbances of V. of N of page

Philosophy of treatment

Treatment is directed to elimination of the main reason which caused V.'s disease of N of page; first of all this treatment of diseases of c. N of page and internals.

At vegetative syndromes with increase in a tone of a sympathetic part use the drugs reducing it — the central adrenolytic drugs (Reserpinum, propazine); at defeat of vegetative nodes — ganglioblokator (Pachycarpinum, Pentaminum, Hexonium); at suffering of peripheral devices — spasmolysants (a papaverine, Nospanum, an Euphyllinum, Redergamum, Platyphyllinum). The central M-cholinolytics (atropine, Tropacinum, Cyclodolum, amizyl, etc.) and peripheral N-cholinolytics (ganglioblokator) are reasonable at increase in a tone of parasympathetic department. Also the drugs of the combined action suppressing pathological sympathetic and parasympathetic activity — Belloidum, bellaspon, bellargol, sedanon, etc. are used.

Novocainic blockade of the corresponding vegetative nodes and intravenous injection of novocaine give good effect. Also the balneoterapiya is appointed fizio-(an electrophoresis with novocaine and analginum, an Euphyllinum, mud applications, local and general hydrosulphuric and radonic bathtubs).

In hron, persistent cases apply a roentgenotherapy of the struck vegetative nodes, and also surgical treatment.

Surgical interventions on the autonomic nervous system. Their development belongs to 20 — 40 20 century and is connected with names of V. A. Oppel, P. A. Herzen, A. G. Molotkov, R. Lerish, W. Mac Gregor and their followers.

Operations on V. of N of page are diverse, but in most cases have character of a symptomatic action. Depending on localization of defeat and results of operation distinguish interventions on a sympathetic and parasympathetic nervous system.

Interventions on a sympathetic nervous system are divided into sympathectomies and simpatikotomiya. To sympathectomies (see) refer partial or full removal of a chain of nodes of a sympathetic trunk. The group of partial sympathectomies is made a resection of a sympathetic trunk between nodes, by trunkular sympathectomies, periarterial sympathectomies (removal of a carotid glome, adventitia of arteries), a resection of the affected arteries. Treat crossing of a boundary trunk between nodes simpatikotomiya, internodal ramicotomies (see), angioliz arteries and veins, a section of sensory cutaneous nerves which part sympathetic fibers are (A. G. Molotkov. 1939).

Distinguish also full and partial resection of sympathetic textures of an abdominal cavity, a basin, edge in combination with gangliectomy (see) leads to a relative desimpatization of bodies and certain areas of an organism.

Operations on a sympathetic nervous system make at various diseases (disturbances of blood circulation, a trophicity, secretion, pigmental exchange, at a pain syndrome, inflammatory processes). According to F. M. Lampert (1945), diseases at which the desimiatization is applied can be conditionally divided into the following groups.

1. Disturbances of blood circulation with dominance of the ischemic phenomena (an idiopathic hypertensia, a Raynaud's disease, a Crocq's disease, an eritromelalgiya, an obliterating endarteritis, thrombosis of vessels, etc.).

2. Pain syndromes of a visceral and vascular origin (angina pectoris, tabic crises, hron, cystitis, gastralgias, shingles, kauzalgiya, pains after amputation of extremities, dysmenorrheas, a vaginismus, a pelvic plexitis, neuralgia, nonresectable tumors).

3. Defeats went. - kish. path (disease of Girshprunga, cardiospasm, pylorospasm

4. Spastic paralyzes, hron, hepatitis and cirrhosis, hron. pancreatitis, trophic frustration of soft tissues and bones, scleroderma.

Practically the surgery of a sympathetic nervous system is a hl. obr. «surgery of pain». The mechanism of antalgichesky action of interventions on a sympathetic nervous system consists in a break of peripheral boleprovodyashchy fibers from preferential visceral bodies and in change of a vazomotorika, biochemistry of fabrics in the center of pain. The result of operations on a sympathetic nervous system amplifies in their combination to the actions eliminating substrate of defeat (e.g., at a kauzalgiya the gangliectomy is successfully combined with elimination of the center of an irritation). Pursuing the aim to create fuller desimpatization of the struck bodies and areas of an organism, make a gangliectomy of two, three and more nodes together with a resection of splanchnic nerves (splanchnicectomy), sympathetic textures.

Operative measures on a sympathetic nervous system at vegetalgias, kauzalgiya of top and bottom extremities are effective (gangliectomies of the II—III chest sympathetic nodes, S.Yu. Minkin, 1946; K. A. Grigorovich, 1964, 1968). Forms and stages about l of the iterating endarteritis at which there are successful belly gangliectomies are established. The role of the III chest sympathetic node in regulation of blood circulation is proved (B. V. Ognev, 1957) and positive takes to an issla of its gangliectomy in cases of a circulatory disturbance in the lower extremities are received. The resection of the thrombosed arteries in fight against amputating pains is considered reasonable, and also at treatment of temporal arteritis. Interventions on pelvic department of a sympathetic nervous system (an upper hypogastric, presakralny texture, a presakralny nerve) at the patients suffering from a pain syndrome at a dysmenorrhea, a vaginismus [G. Cotte, are successful 1932; I. I. Orlov, 1930; R. A. Boyko, 1937; V. S. Mikhaylovsky, 1966, 1967].

Operations on a sympathetic nervous system are usually preceded by blockade of sympathetic nodes and textures novocaine (lidocaine) which can carry diagnostic and lay down. character (see. Novocainic blockade ). Temporary or more permanent switching off of pain, temperature increase of skin in the struck segment after blockade of sympathetic nodes define expediency of the subsequent sympathectomies at an endarteritis, a Raynaud's disease, a pain syndrome in chest or belly cavities. Blockade of sympathetic educations specifies the volume, level and the forecast of operative measures.

Interventions on a parasympathetic nervous system are carried out by hl. obr. on peripheral department of a vagus nerve. At so-called carotid and sinus epilepsy, and also in cases of disturbance of cerebral circulation removal of a sinocarotid node is used. Various methods vagisections (see) are applied at bronchial asthma, angina pectoris, at a cardiospasm, a peptic ulcer of a stomach, a duodenum etc. At neuralgia of the wandering, glossopalatine nerves, in addition to a radicotomy, section of the descending paths [Z.Kunc, 1964] the specified nerves in a myelencephalon found application (see. Tractotomy ).

Efficiency of intervention of N of page is defined by correctness of indications to operation which are specified by additional diagnostic manipulations, and also a strict anatomichnost and care of its carrying out on V.


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Яндекс.Метрика