SHISHKOVYDNY BODY. Contents:
Comparative anatomy...... 44 9
Pathological anatomy..... 451
Methods of a research........ 451
Pinus [corpus pineale (PNA, JNA, BNA); synonym: pineal gland, strobiloid gland, an epiphysis, conarium] — the hemaden of a neyrogli-alny origin relating to an epithalamus of a diencephalon and participating in processes of maintenance of a homeostasis.
History. For the first time the Ancient Greek doctor Gerofil reported about a pinus (Herophilus, a sort. apprx. 300 BC), attributing it function of control of cerebration of the person. Highway of t., considered the valve regulating course of «vital spirit», body «a prediction and clairvoyance», «a receptacle of soul». First anatomic description of TTT. t. attribute to K. Galen, to-ry called this gland a pinus for external looking alike a fir cone and considered as option limf, glands. First image of Sh. of t.
A belongs. Vezaliya (1543), to-ry believed that function Sh. of t. consists in regulation of circulation of cerebrospinal liquid in cerebral cavities. From 17 century under the influence of French philosopher-duali-hundred R. Descartes idea of Sh. of t begins to dominate again. as about «a receptacle of soul». In 1695 the Russian scientist
of B. Jurassic published work «About a pinus», in a cut considered Sh. of t. as lymphatic gland. Gibson attributed Sh. to t. function of division of blood and lymph. Afterwards in literature descriptions of pathomorphologic changes and a histologic structure of a pinus appeared. Highway, Vinslou (1732), K. Burdakh (1822), to Sappa (M. Ph. The page of Sappey, 1877) carried a pinus to nervous gangliya. F. Genle (1879), Shvalbe (G. And. Schwalbe, 1881), Toldt (To. Toldt, 1885) considered Sh. t. gland. For the first time in 1898 Heybner (J. The island of L. Heubner) paid attention to interrelation of tumors of a pinus with premature puberty and suggested about endocrine function Sh. of t.
Prior to the beginning of the 60th there are 20 century views of function Sh. of t. were extremely contradictory. There was an opinion that it is a rudimental organ or the closed gland functioning only before puberty. In 1958 Lerner (A. V. Ler-ner) with sotr. allocated from extracts Sh. of t. bulls organospetsifichesky substance — melatonin, and afterwards established its chemical structure and synthesized in laboratory. In 1968 Mr. R. J. Wurt-man, J. Axelrod (see t. 10, additional materials) and D. E. Kelly found out that synthesis of melatonin in a pinus within a day proceeds with various intensity. It was suggested about Sh.'s functioning by t. as peculiar biological clock. Continuous light radiation of rats caused in them oppression of activity of vol. of t., what stimulated growth of a body and led to increase in gonads.
Researches of Caper (A. Kappers, 1960, 1965), Goldman (S. Goldman, 1964), E. I. Chazova and sotr. (1972, 1973), A. Oksche and sotr. (1963, 1967), t confirmed to Kelly (1965) Sh.'s role. in neuroendocrinal regulation.
Comparative anatomy. Highway of t. arises at vertebrata as one of unpaired median protrusions of a roof of a diencephalon. At the lowest vertebrata two such protrusions are put, from to-rykh develops parapineal (parietal) and pineal (epiphysis) bodies. The parapineal body at many fishes and nek-ry reptiles is differentiated in specialized light-sensitive body — a pineal eye. At Sh.'s fishes of t. has the form of the bubble located superficially under a calvaria. In a pinus cells are found in reptiles along with cells of touch type, the Crimea attribute secretory function. According to Byunyo-na and Moreau (S. of Bugnon, N. Moreau, 1964), these cells demonstrate evolution of photoreceptor cells in ^ endocrine. At amphibiouses the pineal body (epiphysis) consists of actually Sh. of t. and pacnoj lozhenny directly under skin of the frontal body containing at amphibians (at tadpoles) at early stages of development photoreceptor cells. At adult individuals photoreceptor cells are replaced with glial fabric, and Sh. in t. it is presented by meshkoobrazny protrusion of a roof of a diencephalon. Highway of t. is available almost for all species of reptiles, except for crocodiles. At birds of typical sensory cells in Sh. of t. no, however the susceptibility of pineal cells to light radiation remains. At mammals and the person Sh. of t. develops from the remained proximal part of pineal body and differs in a form, the sizes and topography.
Embryology. The germ of the person on 5 — the 7th week of pre-natal development in the field of a roof of a diencephalon has an unpaired hollow protrusion — an epiphyseal diverticulum, a front wall to-rogo is spliced with commissure of leads, and back — with epitalamichesky commissure (back commissure of a brain). The cells which are a part of front and back walls of an epiphyseal diverticulum begin to share intensively, forming front and back shares of Sh. of t., to-rye merge in uniform body. The rest of a cavity of an epiphyseal diverticulum in Sh. of t. at adults represents the small sacculate deepening (a pineal pocket) which is in the basis of gland and reported with a cavity of the third cerebral cavity. In the same area the ependyma of the third ventricle gives rise to so-called subkomis-suralny body. In the embryonal period a back share of Sh. of t. develops from an ependyma of subkomissuralny body.
On 7 — the 8th week of pre-natal development in Sh.'s rudiment of t. the connecting fabric containing vessels grows. Uneven growth of surrounding Sh. of t. formations of a brain leads to the fact that originally vertically growing gland is displaced kzad and holds horizontal position over a plate of a roof (chetverokholmiya), addressing the top a cerebellum. By the time of the birth of a fruit of Sh. of t. it is similar on the structure to this gland at the adult, the weight (weight) of a pinus of newborns on average apprx. 8 mg.
Anatomy. The pinus represents unpaired roundish or spherical formation of reddish-brown color.
Highway of t. the adult has length of 5 — 15 mm, width of 3 — 10 mm, thickness of 2 — 6 mm, weight (weight) apprx. 170 mg. Highway of t. it is located on the median plane deeply under cerebral hemispheres (hemicerebrums, in T.). Sh.'s top of t. the chetverokholmiya lies in a furrow between two upper hillocks, and the basis is directed kpered and adjoins the tail of the third ventricle (see tsvetn. the tab. to St. Brain, t. 6, Art. 272 — 273, fig. 1). The front share of gland is spliced with commissure of leads (commissura habenularum) and epitalamichesky, or back, commissure (commissura epithaiamica). Commissure of leads in side departments continues in leads (habenulae), to-rye, extending also forming triangles of leads (trigonum habenulae), grow together with the medial surfaces of a thalamus (thalamus). Ventral, usually more convex, Sh.'s surface of t. is in the peculiar bed formed by the furrow separating from each other upper hillocks of a roof of a mesencephalon (see). To a dorsal surface of Sh. of t. prilezhit nadshishkovidny deepening, or a nadpinealny pocket (recessus suprapinealis), to-ry it is sometimes rather well-marked and it is reported with a cavity of the third ventricle. Over a dorsal surface of Sh. of t. the commissure of the fornix and the roller of a corpus collosum hangs.
Morphologically and functionally with III. t. the subkomis-suralny body consisting of several layers of the cylindrical cells of an ependyma covering a back wall of the third ventricle between a silviyevy water supply system is closely connected (a water supply system of a brain, T.) and Sh. of t. lower than commissure of leads. The Subkomissu-ralny body well vaskulyari-zirovan, but has no own innervation. At the person the subkomis-suralny body is developed poorly and on the 5th year of life is substantially reduced. There is an assumption that at the same time functions of subkomissuralny body entirely pass to a pinus. According to A. M. Helimsky, Sh. of t. and subkomissuralny body represent a uniform complex like a complex a hypothalamus — a hypophysis.
Sh.'s blood supply t. occurs at the expense of branches of front, average and back brain arteries. On a surface a chetverokholmiya around Sh. of t. the dense arterial network, from a cut in Sh. is formed by t. on connective tissue partitions from 6 to 10 branches depart. Outflow of a venous blood happens in a big brain vein or its inflows and to sine of a firm meninx. Limf, capillaries in Sh. of t. are not found.
Sh.'s innervation of t. it is carried out by sympathetic nerve fibrils of upper cervical nodes of a sympathetic trunk, to-rye, approaching Sh. t., form a strobiloid nerve (n. pinealis). Besides, Sh. of t. it is connected with kernels of leads, tapes of a thalamus (taeniae thalami) and a plate of a roof of a mesencephalon.
Histology. From the gentle connective tissue capsule surrounding Sh. with t. and the soft (vascular) cover of a brain which is continuation (see the Meninx), in depth of gland the layers dividing a parenchyma into segments and forming a stroma of gland depart. Sh.'s parenchyma of t. consists of pineal and glial cells. Distinguish light and dark pineal cells (pinealotsita, or pineotsita). Light pinealotsita (main, or cells of the I type) — big cells with roundish light kernels and the cytoplasm which is badly painted by usual dyes having a large number of short and long cytoplasmatic shoots; the shoots which are localized near capillaries terminate in club-shaped utolshche-iiya. Dark pinealotsita (a cell of the II type) — small cells with dark kernels and the cytoplasm containing acidophilic or bazofil-yay granules. Existence in cytoplasm and cytoplasmatic shoots of pinealotsit, various in a form, the sizes and electron density of granules of a secret and vesicles, testifies to a peculiar form of deposition of products of secretion in them. There is an assumption that light and dark pinealotsita are not different types of cells, but the same cells in various functional state. Glial cells (gliotsita) of a various form and localization belong to fibrous astrocytes (see the Neuroglia).
Allocate several types of a structure of Sh. of t.: cellular, trabecular and alveolar. The cellular type occurs at newborns and children of early age and the t is characterized by total absence or insignificant quantity in Sh. elements of a stroma. The trabecular type differs in growth of a stroma, edge, however, completely does not isolate from each other sites of a parenchyma. The alveolar type is more often observed at advanced and senile age and characterized by a lobular structure of gland. In layers of connecting fabric along with cells inherent to it a large number of glial elements is found.
Physiology. The pinus takes part in such vital processes as growth (see), puberty (see), providing a homeostasis, and also interrelation of internal environment of an organism and the environment. Its main function is regulation of circadian (daily allowance) rhythms and adaptation of an organism to the changing conditions of illumination (see. Biological rhythms). In the course of evolution Shch. t. from touch body turned into secretory.
In Sh. of t. biologically active compounds, first of all indolilakilamina, such as serotonin (see), melatonin (see) and other metoksiindola, and also noradrenaline (see), a histamine (see), etc. contain. The high level of exchange of these substances in Sh. is noted by t. In addition to predecessors and derivatives of serotonin, in Sh. of t. find various peptides — arginine - vazoto-tsin, lyuliberin, tiroliberin, about-laktiningibiruyushchy and prolactin-rileasing hormones, etc.
Existence in pinealotsita along with peptide hormones of biogenic amines, and also ability to capture and decarboxylation of their predecessors allows to carry cells of a pinus to neuroendocrinal, or to cells of APUD-system (see t. 20, additional materials).
Highway of t. represents the peculiar neuroendocrinal transmitter operating by the principle «nervous impulse — emission of hormone». A specific irritant for III. t. the light signal serves. Lighting (taking into account a light spectrum) slows down transformation of serotonin into melatonin and other metoksiindola and promotes accumulation in Sh. of t. serotonin and its metabolites which are formed in the course of oxidizing deamination. In the dark there is a strengthened transformation of serotonin into N-acetyl-serotonin, and the last in melatonin. This process is carried out under the influence of two main enzymes — N-acetyltransferases and guides-roksiindol-0-methyltransferases, activity to-rykh also depends on the mode of lighting. Existence of day-night and seasonal rhythms fiziol. Sh.'s activities of t., the peripheral closed glands matching rhythms of secretory activity, allows to consider it the regulator of a biological clock in an organism. Content of melatonin in a blood plasma of the person makes 60 — 140 pg at night! ml, in the afternoon — lower than 50 pg! the ml, concentration it reaches a maximum — apprx. 3 hours of night. Excretion of melatonin with urine (generally in the form of 6 oxymelatonin) makes, according to Lynch (H. J. Lynch, 1975) and sotr., 0 — 26,4 ng for the 8-hour period, about 60 — 70% of melatonin are removed with urine between eleven o'clock in the morning and seven o'clock in the morning.
Cyclic nature of synthesis and secretion of metoksiindol of Sh. of t. it is caused by influence of a supraoptic (suprakhiazmatichesky) kernel of a hypothalamus (see) where on retino-hypothalamic ways the signal from photoreceptors of a retina arrives. An intermediate link in signal transmission from a supraoptic kernel to Sh. of t. the upper cervical sympathetic node is. Regulation of allocation of metoksiindol is provided with cyclic changes of sensitivity the r-adrenoretsepto-ditch of pinealotsit to influence allocated from sympathetic rubbed-minaley noradrenaline and a rhythm of allocation of noradrenaline causing activation of N-acetyltransferase while activity a hydroxyindole-au-methyltrance-ferazy depends generally on endogenous hormonal influences.
Assume that in connection with high sensitivity to changes of magnetic field of Earth of Sh. of t. represents the peculiar «compass» participating in orientation of animals in space (see. Magnetic field). Highway of t. has ability to differentiation and the subsequent integration of data on various influences of the environment on an organism and adaptation of system of a hormonal homeostasis to them. Difficult adaptive function Sh. of t consists in it.
Sh.'s influence t. on endocrine system generally has inhibitory character. Administration of melatonin causes decrease in synthetic activity of a hypothalamus, reduction of the weight (weight) of a hypophysis (see) and contents in it melanotsitostimuliruyushchy hormone (see), luteinizing hormone (see), follicle-stimulating hormone (see), thyritropic hormone (see) and adrenocorticotropic hormone (see). The water extracts received from fabric Sh. of t., have effect, in many respects similar to melatonin. During removal of III. t. the mass of a hypothalamus increases, the number of mitoses in cells of an adenohypophysis accrues and the content of its hormones in blood increases.
The mechanism of effect of melatonin at the hypothalamic level in many respects is represented not clear. It is not finalized whether melatonin makes immediate effect on a hypothalamus or mediated, through I serotoninergiche-will hold down system (see Serotonin). (See) it influences secretion of triple hormones of a hypophysis, apparently, by means of change of level of hypothalamic neurohormones (see) as administration of melatonin not -' is mediocre in portal system of a hypophysis, as a rule, not effectively. At the same time parapituitary influence of melatonin on nek-ry peripheral closed glands is established (impact on bark of adrenal glands by change of activity of reductases, influence on ekstratireoidny transformation of thyroxine into triiodothyronine, on the level of insulin in blood and tolerance of an organism to glucose). In 1959 Mr. G. Farrell and sotr. allocated from acid extracts Sh. of t. the substance stimulating secretion aljdoste-Rhone (see) also called its adrenoglo-merulotropiny. Adrenoglomerulo- tropine was chemically identified and synthesized afterwards. However the convincing evidence of its active participation in regulation of a water salt metabolism is not obtained.
Effect of hormones Sh. of t is most expressed. on system a hypothalamus — a hypophysis — gonads. Sh.'s influence t. on somatic and sexual development P. Foa was for the first time proved in 1912. At chickens during Sh.'s removal of t. in 3 — 5 weeks age rapid growth of a comb, early awakening of a sex instinct, emergence of ability to singing and increase in seed plants in comparison with cockerels of the same age from control group were observed. Similar data are obtained also in experiments on mammals. An-tigonadny the effect is rendered by melatonin, and also the nek-ry peptides which are contained in Sh. of t. However results of further experimental studying of interrelation of Sh. of t. with reproductive system changed earlier developed ideas
of Sh. of t. (in particular, its hormone melatonin) as about universal inhibitor of endocrine functions because in nek-ry cases of Sh. of t. acts as the activator of reproductive function. It is shown that action is exogenous the entered melatonin in many respects it is caused by a condition of the receptor device in target organs and other conditions (Sh.'s safety of t., functional condition of endocrine system).
Sh.'s role of t. as neuroendocrinal transductor and regulator of cyclic processes in system a hypothalamus — a hypophysis — gonads it is especially essential to a female body. Normal function Sh. of t. changes according to phases of a menstrual cycle (see). In the conditions of pathology the retsiproknost of relationship between functional activity of Sh. of t is broken. and condition of gonads.
Hormones Sh. of t. oppress bioelectric activity of a brain and psychological activity, rendering somnolent, analgesic and sedation. At patients with a depression (see. Depressive syndromes) and persistent sleeplessness (see) reduction of excretion of melatonin with urine is noted. Disturbance of a rhythm of allocation and level of secretion of melatonin is so often combined with mental diseases that is considered by nek-ry researchers as their genetic marker. Certain influence of Sh. of t. renders on tumoral processes in an organism. During removal of a pinus at laboratory animals acceleration of development of a melanoma, growth of the tumors induced dimetilbenzantra-tseny is observed. The water and alkaline extracts received from fabric Sh. of t., have antineoplastic effect, to-ry connect with stimulation of immunocompetent cells (see), macrophages, etc.
Pathological anatomy. Carry Sh.'s agenesia of t to malformations. up to its absence (apinealizm), and also Sh.'s ectopia of t. in thickness of the subject tissue of a brain. This pathology meets extremely seldom as an accidental find at a pathoanatomical research.
Among proteinaceous dystrophies in Sh. there is a t. the amyloidosis and a hyalinosis of vessels meet (see the Amyloidosis, the Hyalinosis), to-rye are observed at a generalized amyloidosis, an idiopathic hypertensia with preferential defeat of vessels of a brain. At patients with malignant tumors are noted fatty dystrophy of pinealotsit (see. Fatty dystrophy) and deposits of lipids in a stroma of gland.
In a pinus signs of calcification often come to light (see), the pathogeny to-rogo is not clear. One researchers consider Sh.'s calcification of t. as fiziol. the phenomenon as deposits of salts of calcium are observed already at early children's age, others — as involutional. Small granules of salts of calcium, or so-called brain sand, are located near vessels. Occasionally cells of a parenchyma are exposed to calcification.
In Sh.'s cells of t., especially near calcificats, the brown pigment — melanin contains (see). In a stroma of gland, it is frequent in the neighbourhood with blood vessels, lipofuscin is found (see), to-ry consider as reserve material for construction of new structures of body.
In a pinus sites of a gliosis (see) — growths of an unspecialized neuroglia on site of earlier functioning fabric Sh. of t meet. The gliosis arises both at healthy faces, and at patients (at rheumatism, a hypertension, renal arterial hypertension). In the depth of sites of a gliosis the necrosis can be noted, at the organization to-rogo the adventitious cyst is formed (see below). Sites of a necrosis in Sh. of t. come to light also at ischemic strokes and intoxications.
Disturbances of blood circulation (a staza, hemorrhages, a hyperemia, ischemia) are usually connected with the general disturbances of cerebral circulation, hemorrhagic diathesis, with inf. diseases (sypny, is more rare belly, typhus), intoxications, nefrotsirrozy; at the last there are massive hemorrhages, on site to-rykh cysts form. In walls of such cysts accumulations of hemosiderin are usually localized (see the Hemosiderosis). Hematencephalons can be followed by hemorrhage in Sh. of t., is more often in its front share. At abscesses of a brain and cerebellum, purulent meningitis and sepsis in veins Sh. of t. the thrombosis leading to ischemia (see) fabrics of gland can be observed.
Sh.'s inflammation of t. always has secondary character. The acute purulent inflammation arises at purulent meningitis, abscesses of a brain, sepsis. At tubercular meningitis in Sh. of t. tubercular hillocks can form, and at inborn syphilis — gummas. The result of chronic inflammatory process is the sclerosis (see) Sh.'s fabrics of t., the type more often mixed (gliosis-but-connective tissue), with formation of cysts.
Sh.'s cysts of t. can arise to at healthy faces, and also at patients, it is especially frequent at rheumatism, a hypertension, renal hypertensia. In these cases on site of a nekrotizirovanny central part of the gliozno-changed fabric the so-called adventitious cyst (the cavity deprived of own vystilka) forms. Adventitious cysts are formed also as a result of acute hypostasis of Sh. of t. during the drowning, and also tetanus, rage and other neuroinfections.
True cysts are covered ependimny, pineal, but most often by glial cells. The fabric surrounding cysts is rich with argyrophil fibers. Large multiple cysts of Sh. of t. quite often simulate a tumor, especially at hemorrhages in their wall. Such cysts put pressure on sil-viyev a water supply system and lead to secondary hydrocephaly or a local prelum of a brain. Small cysts clinically are not shown. The quantity them can increase at patients with malignant tumors.
Sh.'s hyperplasia of t. it is observed seldom, generally in the prepubertatny period, and is considered as fiziol. state.
Sh.'s hypertrophy of t., mostly false, it is connected with massive adjournment of salts of calcium, formation of cysts, especially multiple.
Methods of a research. For a research of function Sh. of t. apply the biological testing based on ability of melatonin to clarify melanophores of amphibians. Content in urine of the main metabolite of melatonin — 6 - oksimelatoni - on — define by a flyuori-metriya (see), and reveal concentration of melatonin in a blood plasma and cerebrospinal liquid by a ra-dioimmunologichesky method (see), and also by means of a gas liquid chromatography (see) with the subsequent mass spectrometry (see). For definition of nek-ry pineal me-toksiindol use immuno-histologic and various radionuclide methods. Indicator of functional activity of Sh. of t. activity of the main enzymes participating in formation of metilirovanny pineal indoles can also serve.
Fig. of Ventrikulogramm at a tumor of a pinus (a side projection): 1 —
defect of filling of back departments of the third ventricle; 2 — silviyev the water supply system displaced basally with occlusion of its caudal departments.
Research Sh. of t. includes also a X-ray analysis (see) and a computer tomography of a skull (see the Tomography computer). In 50 — 75% of cases on craniographies at adults in Sh. of t. the calciphied inclusions having an appearance of the kroshkovidny educations which are often collected in a conglomerate of di-am come to light. 3 — 6 mm, reminding mulberry berry in a form. Thanks to the fact that it is normal of Sh. of t. is located, as a rule, at zadnenizhny border of the third ventricle and often contains calcificats, its shadow on kraniogramma serves as a reference point at detection of intracranial pathology. On a direct kraniogramma of Sh. of t. it is located strictly on the centerline. Sh.'s removal of t. confirms existence in a head cavity of volume education (a tumor, abscess, etc.) or the cicatricial or atrophic center (see fig. 4 to St. Craniocereberal injury, Art. 307). The simplest technique of definition of localization of Sh. of t. in the absence of calcificats in it it is developed by Oon (C.L. Oop, 1964). On the kraniogramma executed in a side projection, a straight line connect a hillock of the Turkish saddle and a first line of a big (occipital) opening. 1 cm below than a hillock of the Turkish saddle to this line recover a perpendicular, on Krom of two lines 5 cm higher than a point of intersection Sh. is located t.
The computer tomography is the main diagnostic method of tumors of Sh. of t. (see below).
With the diagnostic purpose the electroencephalography can be used (see). It is known that change of functional activity of Sh. of t. influences amplitude of waves and - a rhythm. Significantly expanded possibilities of diagnosis of tumors of Sh. of t. use of such methods of inspection as a cerebral angiography (see), a pneumoencephalography (see), a ventrikulografiya (see). On angiograms at the same time the expressed shift and deformation of vessels of III are defined in various degree. t. Administration of oxygen or radiopaque substance in cerebral cavities allows at volume processes in Sh. to t. to reveal the shift of cerebral cavities, change of their form and size (fig). A question of expediency of use of a pneumoencephalography at the expressed likvorny hypertensia (see. Cerebrospinal liquid) is solved the neurosurgeon in an individual order in connection with a certain risk degree.
Pathology. Sh.'s absence of t. (api-nealizm) clinically is not shown since a lack of the substances synthesized by Sh. in t., apparently, it is compensated by other closed glands (see the Hypothalamus, the Hypophysis, Adrenal glands, Endocrine system).
According to the classification offered in 1969 by A. M. Helimsky allocate disturbances of hormonal functions Sh. of t. (hyperpinealism, gipopinealizm, dispinea-lizkhm) and Sh.'s defeats t., followed by intracranial hypertensia and proceeding with endocrine frustration or without them (e.g., tumors).
The hyperpinealism is the passing disturbance caused by increase in secretion of hormones III. t. Increase in activity of the corresponding fermental systems is its cornerstone at nek-ry neurologic, somatopathies and maniac-depressive psychosis. In some cases hyperfunction of III. t. it is caused by persistent subkomis-suralny body. A peculiar form of a hyperpinealism is represented by increase in functional activity of III. t. in connection with inclusion of a negative feedback mechanism in system a pinus — peripheral closed glands, in the relation-rykh to Sh. of t. acts as inhibitor.
Gipopinealizm arises at proteinaceous starvation and a lack of tryptophane, at avitaminosis of B6, deficit tryptophane hydroxylase or
5-oxytryptophanes-decarboxylases. The lack of tryptophane (see), being the predecessor of pineal indoles, leads to decrease in their education. Gipopinealizm can develop also owing to decrease of the activity of a row of fermental systems, in to-rye in the form of pyridoxal phosphate (see) polyneuramin enters.
The dyspinealism is observed at proteinaceous starvation and a lack of methionine, at deficit pantothenic to - you. hypovitaminosis of B2. The lack of methionine (see) influences processes of methylation of indoles as 5-adenozil-methionine is a donator methyl of ny groups. P antotenovy acid (see) is a part of the acetyl coenzyme A connected with processes of acetylation of serotonin; hepatoflavin (see Riboflavinum) is necessary for synthesis of FAD which is a coenzyme of the monoamine oxidase destroying serotonin. In this regard deficit of hepatoflavin leads to accumulation of serotonin in the afternoon and to excess of melatonin in night-time.
Diagnosis of the listed above functional disturbances is based on determination of content of melatonin in a blood plasma and its metabolites in urine. Change of content of melatonin in biol is noted. liquids at patients with various somatopathies (a myocardial infarction, acute nephrite, eczema, cirrhosis, etc.). In an acute stage of traumatic shock (see) signs of activation, and in the remote period — symptoms of functional exhaustion of Sh. of t are found.
For compensation of functional disturbances of Sh. of t. use the drugs containing missing vitamins or other ingredients. The question of expediency of inclusion in complex therapy of the drugs containing pineal me-toksiindola and peptides or their inhibitors is at a stage of studying. Drug of one of Sh.'s tags-siindolov of t is allowed for practical application. — Mexaminum (see) having the expressed radio pro-tektornoy activity; he is appointed the patient receiving radiation therapy.
Organic lesion of Sh. of t. it is observed at Sh.'s tumors of t., syphilis and tuberculosis, cysticercosis, hemorrhage in Sh. of t., and also at tumors of a gray hillock, bottom of the third ventricle, internal hydrocephaly, inflammatory processes in a diencephalon. The basic the wedge, a syndrome at the same time is premature puberty, including an early macrogenitisomia (see the Pinealoma). The pathogeny of an early macrogenitisomia is not absolutely clear. Believe that it is caused by secretory insufficiency of Sh. of t. Nek-ry researchers connect its development with inflammatory or dystrophic processes in a diencephalon, and also in a hypothalamus.
Close functional interrelation between Sh. of t. and a hypothalamus causes certain difficulties in differential diagnosis of defeat of Sh. of t. and the diverse disturbances of a functional condition of the hypothalamic centers arising on an organic basis. Besides, manifestations of hypothalamic disturbances can directly join in symptomatology of defeat of Sh. of t. At diagnosis of organic lesion of Sh. of t. existence of signs of premature puberty, increase in intracranial pressure is considered (see. Hypertensive syndrome) and focal defeats of area of a hypothalamus. Besides, use radiological methods of a research Sh. of t., with the help to-rykh reveal Sh.'s removal of t., its calcification, deformation of cerebral cavities, symptoms of intracranial hypertensia (discrepancy of seams of a skull, expansion of an entrance to the Turkish saddle, etc.).
Differential diagnosis of the endocrine disturbances arising at Sh.'s defeats t., carry out first of all with hormonal and active tumors of bark of adrenal glands (see) — an androsteroma (see), kortikosteromy (see) and the inborn virilizing adrenal struma. In these cases at boys the hypergenitalism (see the Hypergenitalism) unlike epiphyseal is not followed by a spermatogenesis. At girls the epiphyseal hypergenitalism is not described, and the vi-rilny syndrome (see Virilescence) arises in connection with pathology of adrenal glands or ovaries.
Sh.'s tumors of t., according to various researchers, make apprx. 1 — 1,5% of all tumors of a brain and are most often observed aged from 14 up to 18 years. Germinogenny tumors prevail (germinomas, teratomas, embryonal carcinomas, choriocarcinomas, etc.), to-rye make 50 — 70% of tumors of area Sh. of t. The tumors arising from pineal cells subdivide into pimealomas (pinealomas) and pinealomas. Pimealomas carry to benign tumors. They are encapsulated, sometimes contain cysts. Pinealomas are malignant, quite often metastasize in cerebral cavities, subarachnoidal (subarachnoid) spaces of a head and spinal cord (see the Pinealoma).
Distinguish an all-brain (hyper-tenzionno-gidrotsefalnye) and local wedge, symptoms of tumors of Sh. of t. Gipertenzionno-gidrotsefal-nye signs are caused by a prelum a tumor of a silviyev of a water supply system and back departments of the third ventricle. At the same time are observed the pristupoobrazny headache which is followed by vomiting and dizziness, forced position of the head of the patient during a paroxysm of pain, developments of stagnation in a nipple zritelny nerve (see. Occlusal syndrome). From local symptoms most often there are various visual and oculomotor frustration — weakening of reaction of pupils to light, paresis of a look in the vertical direction, disturbance of convergence, an ophthalmoplegia (see), a hearing disorder. These manifestations are generally connected with defeat by a tumor of a plate of a roof of a mesencephalon. Approximately at a half of patients cerebellar frustration in the form of disturbances of a statics and gait come to light. If the malignant tumor burgeons in basal kernels, then extrapyramidal symptoms come to light.
According to E. JI. Klumbis (1982) and A. N. Konovalova with sotr. (1983), the most informative, exact and safe diagnostic method of tumors of Sh. of t. the computer tomography is. The tomographic picture depends on the sizes and a structure of a tumor, and also on existence of necrotic cavities, cystous changes and inclusions of salts of calcium. On the tomogram the zone of the increased density in the area Sh. of t usually comes to light. in the absence of perifocal hypostasis around a tumor. In some cases Sh.'s tumors of t. on tomograms come to light only by means of contrasting of cerebral cavities. At the same time the full or partial tamponade of the cross tank of a brain, expansion of both side ventricles and front departments of the third ventricle is noted.
Treatment of tumors of Sh. of t. includes their operational removal or carrying out palliative operations, radiation therapy, and also a symptomatic treatment. The choice of a hmetod of treatment is a complex challenge that is caused gistol. variety of tumors of Sh. of t., their interrelation with a brain trunk and an arrangement in close proximity to large blood vessels, and also various radio sensitivity of tumors.
In the presence the gipertenzionno-guide-rotsefalnykh of symptoms make the palliative operations directed to elimination of occlusal hydrocephaly (see).
Operational oncotomy of Sh. of t. it is shown when at the patient the teratoma is supposed (see) or on tomograms the small tumor (diameter does not exceed 25 — 35 mm) comes to light and there are no manifestations of severe defeat of a brain trunk. The volume of an operative measure is determined on the basis of results of an intraoperative biopsy (see). If the tumor malignant, burgeons in a thalamus and a plate of a roof of a mesencephalon, attempts of its total removal are inexpedient. At suspicion on Sh.'s germinoma of t. radiation therapy is shown, to-ruyu carry sometimes out after a partial oncotomy. In cases of detection of widespread tumors of Sh. of t. and existence of the expressed symptomatology of defeat of a brain trunk apply only a symptomatic treatment.
At nonresectable tumors the forecast adverse. During removal of Sh.'s tumors of t, small by the size., not burgeoning in a brain trunk, it is possible to receive satisfactory result.
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