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Pure Autonomic Failure
Published in David Robertson, Italo Biaggioni, Disorders of the Autonomic Nervous System, 2019
Johnson et al (1966) first recognized the importance of intermediolateral column degeneration in the causation of autonomic failure. They described the post mortem on a 66 year old male who had orthostatic hypotension, impotence, anhidrosis and abnormalities on autonomic function testing, without any signs of central nervous system disease. Pathological findings included severe intermediolateral column cell loss with scattered Lewy bodies in the brain and spinal cord without cell loss or gliosis of the pigmented nuclei. The peripheral nervous system pathological examination was unremarkable, showing only reduced nerve fibres with occasional degenerating fibres in some nerve bundles in the sympathetic ganglia. This patient died only 4 years after the onset of his symptoms and, given the limited period of follow-up, cannot be regarded as a definite case of PAF, despite the absence of central nervous system clinical signs on physical examination. Some cases may initially present clinically as PAF but during follow-up central nervous system involvement typical of the SDS may become apparent.
Role Of Neural Substance P And Coexisting Calcitonin Gene-Related Peptide (Cgrp) In Cardiovascular Function
Published in Geoffrey Burnstock, Susan G. Griffith, Nonadrenergic Innervation of Blood Vessels, 2019
The functional significance of the substance P neurons innervating the prevertebral ganglia is not clear, but there is evidence for the release of substance P from the guinea pig inferior mesenteric ganglion by high concentrations of potassium.68 The histochemical observations in combination with biochemical, electrophysiological, and pharmacological evidence, supports the contention that substance P may be the transmitter responsible for generation of the noncholinergic potential elicited in the inferior mesenteric ganglia of the guinea pig.72 Furthermore, substance P may exert modulatory effects on the sympathetic neurons (Figure 12). When applied in concentrations that cause little or no membrane depolarization, substance P potentiates the amplitude of the fast excitatory postsynaptic potential, an effect which frequently results in spike discharge. The physiological role of substance P fibers in sympathetic ganglia is intriguing, though the mechanism of their action has not been investigated in detail. If, indeed, substance P-positive fibers are collaterals of primary sensory neurons, excitation of the primary sensory nerve endings would cause a release of substance P in the central nervous system as well as in the sympathetic ganglia.
Physiology
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Anwen Williams, Martyn D. Evans
The ENS is a division of the autonomic nervous system with which it has extensive connections. It contains complete reflex circuits that detect the physiological condition of the gastrointestinal tract, integrate information about the state of the gastrointestinal tract and provide outputs to control gut movement, fluid exchange between the gut and its lumen and local blood flow. Prevertebral sympathetic ganglia are mediators of the gastrocolic response-mediating tonic and phasic activity after a meal. Sympathetic stimulation causes inhibition of gastrointestinal secretion and motor activity, and contraction of gastrointestinal sphincters and blood vessels. Parasympathetic stimuli typically stimulate these digestive activities. Higher brain centres supply information integrated in the ENS thought to be inhibitory in function.
Histopathology of the Conduction System in Long QT Syndrome
Published in Fetal and Pediatric Pathology, 2022
Alexandra Rogers, Rachel Taylor, Janet Poulik, Bahig M. Shehata
Similar findings were discovered by Bos, Johannisson and Djonlagic in 1985 when examining fatal cases of LQTS in two women aged 20 and 31 [12]. In the SA node, significant fibrosis with minor fatty infiltration lead to disintegration and reduction of conductive tissue and bundles of conduction fibers. The AV node also demonstrated marked reduction of conductive tissue, however this was replaced mostly by adipose tissue instead of fatty infiltration [12]. Interestingly, this study also found inflammatory infiltrates in the sympathetic ganglia of both patients. Based on comparison to 100 randomly selected autopsies, which only demonstrated infiltrations in one patient with ganglion-invading cancer, Bos, Johannisson and Djonlagic determined the inflammatory infiltrates to be characteristic for LQTS [12]. These inflammatory changes are significant, as they may contribute to the onset of arrhythmias and the stratification of clinical severity classically seen in LQTS [12]. We did not discover any similar inflammatory markers in our three pediatric cases of LQTS.
The authors respond
Published in Baylor University Medical Center Proceedings, 2020
Given the chronic nature of psychiatric illnesses with the risk of acute flare-ups, TC has a higher recurrence in these patients.8,9 As such, a patient-centered multidisciplinary approach including a primary care physician, cardiologist, and psychiatrist should be emphasized in the care of these patients with close follow-up to avoid further acute psychiatric attacks and decrease the rate of TC recurrence. Our patient did not have recurrence after her initial episode of TC. Therefore, invasive treatments including sympathetic ganglion blockade were avoided and not considered at the time. Unfortunately, there are no current trials evaluating the treatment of TC, and guideline-directed medical therapy for heart failure is the current standard of care for TC patients.
Vesalius criticism on Galen’s musculoskeletal anatomy
Published in Acta Chirurgica Belgica, 2019
Konstantinos Markatos, Dimitrios Chytas, Georgios Tsakotos, Marianna Karamanou, Maria Piagkou, Elizabeth Johnson
Neurology was the best feature of his anatomical work. Most of the gross structures of the brain were classified by him. He knew the seven pairs of cranial nerves, the cervical, brachial and lumbar sacral plexuses. The sympathetic ganglia were described by him as reinforcers of the nerves. His myology was based mainly on the study of the ape. He understood the difference between origin and insertion, and was aware of muscles’ functions. Among his brilliant experiments were the demonstrations of the function of the laryngeal nerves, the motor and sensory functions of the spinal nerve roots, and the effect of transverse incision and spinal cord hemisection. Galen showed that arteries contained blood and not air and was close to discovering the blood circulation. He is considered as the founder of experimental physiology [4–7].