A study of erythromelalgia in relation to the autonomic nervous system. Report of 321 cases of functional disorders of the autonomic nervous system

A great majority of erythromelalgia were seen among 321 cases of disorders of the autonomic nervous system. When the function of the autonomic nervous system was disturbed, the acromelic blood vessels under the regulation by the autonomic nervous system manifested themselves in the manner of acroerythema, hot sensation, local swelling and distension, and severe acroesthesia.     

Measures of autonomic nervous system activity and lower urinary tract symptoms

Autonomic nervous system (ANS) activity may play an important role in the development of lower urinary tract symptoms (LUTS). Men with severe LUTS and men with mild or no LUTS completed the Valsalva maneuver, quantitative sudomotor axon reflex test, tilt-table, and deep breathing tests. There were no differences between men with severe LUTS compared to men with mild or no LUTS (all P values > 0.05). Systemic ANS tests may not be useful in detecting the underlying physiologic changes that lead to LUTS in aging men.     

Testing the autonomic nervous system

Noninvasive, well-validated clinical tests of autonomic function are available and are in relatively wide use. These comprise an evaluation of sudomotor, cardiovagal, and adrenergic functions. These tests are very useful and have resulted in the recognition of milder degrees of autonomic failure and the presence of orthostatic intolerance that previously were missed. An extensive normative database and commercial equipment is available. The main limitations of the tests relate to the fact that they evaluate mainly the function of target tissues so that the status of autonomic reflexes are inferred. The tests can be affected by medications. There are more invasive, more time-consuming, or less validated tests of autonomic function that can directly record from sympathetic nerve fibers (microneurography) and mesenteric bed to study cerebral vasoregulation and the status of the veins.     

2,5-Hexanedione-induced accumulations of neurofilament-immunoreactive material throughout the rat autonomic nervous system

In rats intoxicated with 2,5-hexanedione, nerve fibres supplying virtually all visceral organs showed large numbers of densely immunoreactive accumulations of neurofilament-like material, of fusiform, elongated, smoothly tapering morphology. In the gut, round to oval, morphologically different lesions were also present, and abnormal neurofilament-immunoreactive accumulations were revealed in oesophageal terminal end-plates. An extensive damage to autonomic nerve fibres, which are largely non-myelinated, was thus revealed in 2,5-hexanedione intoxication. The observed diversity in lesion morphology may suggest heterogeneity in cytoskeletal and/or associated proteins among autonomic neurones.     

Nociception and autonomic nervous system

To observe the effects of minimally invasive procedures for the evacuation of intracerebral hematomas on perihematomal ET-1 expression and their correlation with blood–brain barrier (BBB) permeability. Forty-five rabbits (2.8–3.4 kg body weight) were randomly divided into a normal control group (NC group, 15 rabbits), a model control group (MC group, 15 rabbits) and a minimally invasive group (MI group, 15 rabbits). A model of intracerebral hemorrhage (ICH) was prepared in the MC and MI groups by infusing autologous arterial blood into the rabbits’ brains; the same procedure was also performed in the NC group but without infusing blood into the rabbits’ brains. The intracerebral hematomas were evacuated by a stereotactic procedure in the minimally invasive group 6 h after the model was established. The neurological functions, ET-1 expression and the perihematomal BBB permeability were determined and analyzed in all of the animals. The number of endothelial cells with ET-1-positive expression and the perihematomal BBB permeability significantly increased 1, 3, and 7 days after the ICH model was prepared successfully, as compared to the NC group. In the MI group, however, both measurements decreased markedly compared with the MC group at the same time point. A positive correlation between the number of endothelial cells with ET-1-positive expression and BBB permeability was observed. Increased BBB permeability might be associated with perihematomal ET-1 levels. Minimally invasive procedures for the evacuation of intracerebral hematomas could significantly decrease BBB permeability in perihematomal brain tissues, likely by reducing the production of ET-1.     

Multiple sclerosis and the autonomic nervous system

Symptoms related to alterations of the autonomic nervous system are frequent in patients with multiple sclerosis (MS). Bladder or bowel dysfunction or impairment of sexual performance is highly distressing for most MS patients,whereas the clinical relevance of other autonomic symptoms is less clear. Cardiovascular autonomic alterations might relate to clinical signs such as orthostatic intolerance; a relationship with fatigue is uncertain. However, the frequency of abnormal findings in tests for the cardiovascular autonomic system varies due to the lack of standardized test performance or differentially used cut-off values. The incidence of additional symptoms such as pupillomotor or sweating alterations and especially their relationship to overall autonomic nervous system abnormalities is not well known. Although their impact on daily life is low, they can at least serve as diagnostic tools. Beside these clinical aspects, alterations of the autonomic nervous system have also been reported to alter immunological cascades in experimental conditions. However, corresponding results have not been confirmed in clinical trials yet.     

A survey of different opinions relating to the structure of the peripheral autonomic nervous system

Summary This introductory survey is meant to be a basis for discussion at the round table conference to follow. It summarizes earlier as well as more recent investigations concerning the histological structure of the autonomic periphery dealing also with the so-called interstitial cells and the problem in which way autonomic impulses are transmitted to the effector cells. Special attention is paid to the results of electron microscopic work in this field. They often provide a decisive answer to problems having been discussed since a long time, also bearing out the neurone theory.

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Zusammenfassung Dieses einführende Referat soll eine Diskussionsbasis für die sich anschließende Konferenz bilden. Es faßt frühere wie modernere lichtmikroskopische Untersuchungen über die histologische Struktur der vegetativen Peripherie zusammen und behandelt auch die sogenannten interstitiellen Zellen sowie das Problem, in welcher Weise die vegetativen Impulse den Effektorzellen zugeführt werden. Den Resultaten rezenter elektronenmikroskopischer Untersuchungen wird besondere Aufmerksamkeit gewidmet. Öfters können sie zur Klärung von Problemen beitragen, die vorher seit langer Zeit diskutiert wurden, und bringen außerdem eine Bestätigung der Neuronentheorie.

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Résumé Ce rapport introductif a l'intention de servir comme base de discussion à la conférence de la table ronde suivante. Il rend un résumé des recherches anciennes et plus récentes faites à l'aide du microscope optique concernant la structure histologique des réseaux végétatifs périphériques, traitant également des cellules dites interstitielles et du problème de quelle manière les impulsions végétatives se transmettent aux cellules effecteurs. L'attention spéciale a été dirigée vers les résultats fournis par des investigations au microscope électronique. Plusieurs fois ils peuvent donner une réponse décisive à des problèmes, longtemps discutés, donnant, en outre, une affirmation de la théorie du neurone.

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With 14 Figures

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Diese Conférence de Table ronde fand im Anschluß an das XII. Symposion der Internationalen Gesellschaft für neurovegetative Forschung, Marseille, 12. bis 14. Juni 1962, statt.     

A comparative study of the autonomic nervous system innervation of the thymus in the mouse and chicken

It is well-established that the thymus of rats and mice are directly innervated prenatally by neurons of the central nervous system (CNS). Evidence now suggests that this innervation is involved in determining the neuroendocrine-immune functions of the gland. In this study an analysis of CNS innervation of the chicken thymus was carried out using the horseradish peroxidase (HRP) retrograde transport method to establish the phylogenetic integrity of CNS-thymic innervation and to gain insight into its function. Day-old chicks received HRP injections into upper of lower thymic lobes. Lower injections resulted in HRP-labeled neurons in the ventral horn of the cervical spinal cord and in the dorsal and ventral brainstem complex of the nucleus of X. Injections into upper thymic lobes resulted in similar spinal cord labeling and in labeling of neurons in the nuclei of both IX and X. These injections produced more labeled neurons in the ventral complex of X than did injections into lower thymic lobes. Unilateral HRP injections into upper or lower thymic lobes produced predominantly ipsilateral labeling in the appropriate areas. The results of this study indicate that chick thymuses are innervated by the CNS during embryogenesis. Furthermore, there appears to be a topographical distribution of nerve fibers suggesting discrete functions for individual lobes.     

The autonomic nervous system and fatigue

Behavioral, physiologic and exertional fatigue is differently defined, though symptoms are similar. The beneficial effect of amantadine on fatiguability in multiple sclerosis is accompanied by neuropeptide and lactate changes in the circulation. Exercise sometimes overwhelms temperature regulating mechanisms and may be associated with heat stroke. Endogenous opioids are markedly increased in the circulation during heat stroke and the use of specific opioid antagonists therapeutically has been proposed for heat stroke. Sympathetic activity changes in endurance trained subjects and vasoconstrictor responses are markedly attenuated. Similar changes occur in parasympathetic function which can be abnormal in up to 90% of endurance trained subjects. Hormonal secretion during prolonged exertion is altered and the normal signals (inhibiting or activating feedback mechanisms) are different in endurance trained subjects. Altitude, associated with acute mountain sickness, is also accompanied by an increase in cranial bloodflow. Circadian and temporal variation in autonomic function are manifest by changes in mast cell numbers and 5-HT containing nerve fibers in temple skin of patients with cluster headache. The remission rate induced by vagal stimulation in subjects with intractable hiccups is also affected by circadian hormonal or neurogenic influences.