Search

The study of age and individual anatomical variability of vagus nerves and their branches in different age periods of human ontogenesis causes interest among both morphologists and doctors of different specialties. The aim of the study. To find out the topography of the cervical and thoracic divisions of the vagus nerves in human fetuses aged from 4th to 10th gestational months. Materials and methods. The research was conducted on 75 preparations of human fetuses ranging from 81.0 to375.0 mm in parietal-coccygeal length (PCL) using methods of macro-microscopic dissection and morphometry. Results. In human fetuses, the left vagus nerve is placed anteriorly to the left subclavian artery, then on the lateral surface of the Botallo’s arterial duct and the aortic arch. In the neck region, the superior cardiac branch departs from the left vagus nerve and goes to the anterior surface of the left common carotid artery. In the inferior part of the left common carotid artery, the superior cardiac branch gives off two branches: the middle one reaches the aortic arch wall, and the lateral one runs along the anterior surface of the left common carotid artery. The left recurrent laryngeal nerve departs from the left vagus nerve at the level of the inferior border of the aortic arch. The right vagus nerve passes from the right subclavian artery anteriorly and gives rise to the right recurrent laryngeal nerve, which continues inferiorly and posteriorly around the subclavian artery. The superior cardiac branch originates from the right vagus nerve at the level of the inferior border of the thyroid gland. The inferior cardiac branch departs inferiorly and medially from the right laryngeal nerve and is located on the right anterolateral surface of the trachea. Conclusions. During the fetal period of human ontogenesis, age and individual anatomical variations of the branches of the cervical and thoracic vagus nerves is observed, which is manifested by the variability of the structure, asymmetry of the topography of the recurrent laryngeal nerves, bronchial, esophageal and cardiac branches. The left recurrent laryngeal nerve departs from the left vagus nerve at the level of the inferior border of the aortic arch, the right recurrent laryngeal nerve departs from the right vagus nerve at the level of the right subclavian artery. The esophageal nervous plexus is formed by esophageal branches of the vagus nerves, which then forms mainly the posterior vagal trunk. The anterior vagal trunk is a direct continuation of the left vagus nerve branches. The innervation of the aortic arch involves the common cardiac trunk, which is formed by the superior cardiac branch and the superior cardiac nerve and also anastomoses both with vagus nerve and with recurrent laryngeal nerves.

The aim was to identify sex differences in the cardiac response to cholinergic stimuli in the development of myocardial necrosis and light desynchronosis. Materials and methods. Experiments were conducted in 144 albino rats (72 males, 72 females). Myocardial necrosis was induced by adrenaline (0.5 mg/kg, intramuscularly). The intensity of bradycardia that occurred as a response to intravenous acetylcholine injection and electrical stimulation of vagus nerve was measured. The animals were divided into 4 groups: 1 – rats that were in a light balance (day/night); 2 – rats exposed to light deprivation for 10 days; 3 – rats exposed to permanent lighting for 10 days; 4 – animals exposed to permanent lighting for 10 days and injected with melatonin (5 mg/kg) intraperitoneally 1 hour before the necrosis modeling. Results. The development of myocardial necrosis when occurring in light deprivation was characterized by an increased responsiveness of the rat heart to cholinergic stimulation due to an increase in both cholinoreceptors sensitivity and release of acetylcholine from the vagus nerve terminals in females, and due to only an increased cholinoreceptors sensitivity in males. The development of myocardial necrosis in rats exposed to permanent lighting was characterized by significantly higher sensitivity of cholinergic structures of the heart than that in light balance, especially in females. Melatonin injection in the development of myocardial necrosis contributed to the heart cholinergic structures response to the stimulation, which was close to that observed in conditions of light balance, though it remained somewhat higher: due to the facilitation of acetylcholine release from vagus nerve in females, and it was combined with a higher sensitivity of cholinoreceptors in males. Conclusions. The development of myocardial necrosis in light desynchronosis (light deprivation or permanent lighting) causes an increased heart response to cholinergic stimulation in rats. Such effects are stronger, especially in females in conditions of permanent lighting. The injection of melatonin in rats with myocardial necrosis and permanent lighting results in an approximation (but not restoration) of the heart sensitivity to cholinergic stimuli parameters to those that are observed in light balance. However, the heart response to cholinergic stimulation remains higher, especially in males.

Purpose of the study: to evaluate hearing the vagus nerve’s rhythm in patients with paroxysmal atrial fibrillation.Materials and methods. Observations were carried out in 50 patients with paroxysmal atrial fibrillation who were admitted for catheter-based treatment of arrhythmia. Cardiorespiratory synchronism test was carried out not in atrial fibrillation attack during sinus rhythm with the help of VNS-Micro instrument and software determining the regulatory adaptive status of the human body. The early depolarization zone in the right atrium was mapped using circulatory navigation 20-pole LASSO NAV. Carto-3 system was used to build an electro-anatomic isochronous model of sinus rhythm of the right atrium. The automatic method of annotation of CONFIDENCE module points was applied. At least 500 activation points in the right atrium were set. The observational data and computed values, subject to normal distribution, were processed by parametric statistic techniques using STATISTICA 10.0 software.Results. It has been established that in subjects with low regulatory adaptive capabilities, the length of atrial fibrillation anamnesis amounted to 5.8±0.7 years, and in case of good and satisfactory capabilities — 2.9±0.5 years. The Pearson correlation coefficient between the area of early depolarization zone in the right atrium and disease duration was equal to 0.92.Conclusion. The length of atrial fibrillation correlates with the regulatory adaptive status and area of the early depolarization zone in the right atrium.

Objective: Operational aim: To assess the impact of vagal nerve traction on perinatal maturity of the cervix, among female primiparous in physiological pregnancy. Cognitive aim: Evaluation of the influence of vagus nerve traction on the occurrence of spontaneous labor in primiparous women in physiological pregnancy. Moreover, it was assumed that the technique of traction on the cervical intervertebral spaces between the base of the occipital bone (C0) and the first cervical vertebra (C1) will release and optimize the functioning of the vagus nerve, and consequently accelerate perinatal maturation of the cervix, thus favorably preinducing the delivery. Method: In the research work, the comparative studies were the operational basis, and they were also cross-sectional studies, which consisted of observation. An objective tool – the Bishop scale - was used in the examination of the perinatal cervix maturity. 70 women with physiological pregnancy, 39 + 0 Hbd were qualified for the analysis. Results: The comparative analysis of the subjects showed a statistically significant differentiation in the evaluation of the cervical maturity in favor of GE women, which additionally gave birth closer to the date. Similarly, in the area of opening parameters, shortening of the cervix and the position of the leading point, women performed better on the background of the GK. Conclusion: In comparative studies, it was revealed that traction of the vagus nerve accelerates perinatal maturity of the cervix and spontaneous systolic function occurred closer to the planned date of delivery. The traction of the vagus nerve has a significant impact on the parameter of shortening, opening and lowering of the point of the leading cervix in assessing its perinatal maturity.

The vagus nerve (VN) is the longest nerve of the organism that innervates major organs such as the heart, lungs and gastro-intestinal tract and is a major component of the autonomic nervous system at the interface of the central nervous system and the body. The VN has anti-inflammatory properties both through its afferent fibers, activating the hypothalamic-pituitary adrenal axis, and its efferent fibers activating the cholinergic anti-inflammatory pathway. Targeting these anti-inflammatory pathways is of interest for various inflammatory conditions. Bioelectronic medicine through VN stimulation (VNS) appears as an interesting tool to release inflammatory conditions. VNS is approved for the treatment of drug-resistant epilepsy and has potential therapeutic applications in chronic inflammatory disorders such as inflammatory bowel diseases and others. Preclinical data and pilot clinical studies argue for such an effect. However, larger randomized double-blinded control study and a long-lasting follow-up of the patients to confirm these promising results are awaiting. In addition, the optimal neurostimulation parameters to better treat common conditions and diseases that involve immune regulation need to be determined.

In experiments on anaesthetized cats in the sinoatrial node (SAN), located in induced high-frequency electric field, focus glow (FG) is visualized, which upon stimulation of the vagus nerve (VN) by periodic electrical impulses undergoes significant changes, characterized by FG weakening and its migration, the emergence of pacemaker cells odd pools (PCP); bradycardia and sinus arrhythmia are also observed. Intravenous indole SS-68 derivative (50 mkg/kg) injection which is included in III antiarrhythmic class and is M2 holinoblocator, causes the increase in the FG intensity, its returning to the original location, PCP combination, bradycardia relief and sinus arrhythmia arrest. Under vagal-cardiac synchronization (VCS), caused by VN volleys of electrical impulses stimulation, FG in SAN is intensified and increases its square. PCP are combining thus causing bradycardia. SS-68 (50 mkg/kg) intravenous injection does not cause visible changes in the SAN functional state. It is suggested that the lack of SS-68 activity under the experimental conditions is masked by the processes that occur in the SAN under VCS, that requires additional specific investigations.

In present work the influence of chronic immobilization stress on bactericidal activity of alveolar macrophages after capsaicin application on the neck division of the right vagus nerve and intramuscular administration of leuenkephaline analog dalargine was studied. It was shown that stress is accompanied by the increase of macrophagal bactericidal activity whereas the exhausting of neuropeptides deposit in vagus nerve attenuates this activation. Dalargine caused additional augmentation of bactericidal activity of alveolar macrophages in comparison with stress.

Synergistic action of serotoninergic and cholinergic fibers resulted in augmented vagus heart deceleration when stellate ganglion stimulation was added to vagus nerve stimulation. In such cases expreimental animals developed myocarditis with increased tissue contents of acethylcholine and catecholamines. Blocking S3-serotonin receptors of vegetative ganglia and S1,2 – receptors of the myocardium decreased severity of myocarditis.

According to rough estimates, at least one third of the population in developed countries suffers, to varying degrees, from certain forms of primary headache, the modern pharmacotherapy of which is not always effective and has a number of limitations. The non-pharmacological treatment of headache can be an alternative to the prescription of pharmacological agents and the only possible assistance option for patients developing drug-resistant cephalalgias. This review describes various methods of electrical neuromodulation that are used for the management of primary headaches. The authors provide information on current stages in implementation of implantable and non-invasive equipment into clinical practice, which makes possible electrical stimulations of peripheral nerves and of the sphenopalatine ganglion, as well as allows transcranial magnetic stimulation. Also the appearance and usage of portable electrical devices available on the world market are described, and mechanisms that can underlie anticephalgic action of neuromodulation therapy are discussed. Special attention is paid to the methods that are applied for electrostimulation of the vagus nerve and occipital nerves.

Our experimental study was undertaken to determine the effect of bilateral novocaine vagosympathetic block (VSB) on central hemolymphodynamic and regional hemodinamic in lesser circulation. Follow-up period lasted for 4 hours. No statistically significant arterial pressure changes were detected. Studies of stroke index (SI) and general peripheral vascular resistance (GPVR) changes indentified the development of two responses: (1) a 60% SI decline and PVR increase were accompanied with elevation (mean 37%) of volumetric lymph flow rate within 15-30 min following VSB: (2) there was only a 40% SI elevation and GPVR decline. Rheopulmographic findings detected the reduction of volumetric pulmonary blood flow following VSB, and the decline of both pulmonary tissue-filling and venous bed capacity demonstrated by a significant fall of diastolic wave amplitude within 30 min following VSB. Histologic findings verified the reduction in pulmonary blood-filling following VSB.

The character and values of changes of the pulmonary and systemic hemodynamics following neurogenic stimuli application on the cardiovascular system were studied in acute experiments on the anesthetized cats. Vagus nerve stimulation reduced the heart rate and decreased myocardial contractility in result, right and left atrial pressure increased, whereas pulmonary pressure and flow, venous return, cardiac output and venous return decreased. Pulmonary pressure reached maximal level and returned to the initial value earlier than the pulmonary flow. On the contrary, pulmonary pressure, following neurogenic pressor stimuli, reached maximal level and returned to the initial value later than the pulmonary flow; the sign of the changes of the pulmonary pressure could be positive or negative, whereas pulmonary flow were always increased. The venous return did not change, and for this reason it could not cause the increasing of pulmonary flow which was elevated following increasing of the heart rate and myocardial contractility. The shifts of the pulmonary pressure were correlated with the pulmonary resistance those, which were increased after the stellate ganglion stimulation and decreased following carotid reflex; they did not change in case of sciatic nerve stimulation. The shifts of the pulmonary pressure did not depended on the decreased right and left atrial pressures. When the pulmonary flow was always increased, the cardiac output following electrical stimulation of the stellate ganglion and sciatic nerve was elevated, and it was decreased following carotid reflex, i. e. linear correlation between these parameters were not found. Pulmonary and systemic arterial pressure changes were more obvious in case of direct neurogenic stimuli application comparing with reflectory ones; in both cases, the positive chrono- and inotropic cardiac effects were similar.

The role of lung receptors in respiratory control during acute head-down tilt (AHDT, -30 degrees) was investigated in anesthetized, tracheostomized rats. The results show that AHDT increased the mechanical respiratory load, slowed inspiratory flow, reduced the end expiratory lung volume, tidal volume and minute ventilation. On the other hand, during AHDT a significant rise in inspiratory swings of oesophageal pressure was recorded indicated a compensatory increase in inspiratory muscle contraction force. These effects were reduced after transaction of the vagus nerve. It was also shown that respiratory response on added mechanical load was reduced during AHDT as compared with the value in horizontal position. This deference disappeared after vagotomy. The data obtained suggested that afferent information from lung receptors take part in compensation of respiratory effects of AHDT. The cause of reduction in respiratory response to loading during AHDT involves weakness of lung reflexes evoked by volume changes.

The new class III antiarrhythmic agent cardiocyclide effectively suppresses atrioventricular fibrillations caused by the vagus nerve excitation in narcotized dogs. The electrophysiological effect of cardiocyclide was studied by method of programmed electric stimulation of myocardium on the background of excitation of the a peripheral segment of the right vagus by current pulses of increasing frequency. On this background, cardiocyclide exhibited characteristic effects manifested primarily in the repolarization and the AV node conduction. In addition, the drug eliminated suppression of the sinus and atrioventricular nodes and changes in the atrioventricular conduction caused by the vagus nerve. This drug effect was dose-dependent. The action of cardiocyclide in response to activation of the parasympathetic nervous system was independent of the frequency of the induced heart rate.

Atrial fibrillation (AF) frequently occurred under conditions associated with atrial dilatation (stretch) or vagal hyperactivity. To study possible role of atrial stretch in spontaneous initiation of vagal AF we compared changes of right atrial pressure (RAP) and activation patterns during AF beginning. In anesthetized open-chest dogs (n=45) AF was induced by stimulation of vagal nerves (VS) (30-60 Hz, 5-10 s train). VS resulted in sinus node arrest (4.7+/-0.7 sec) with subsequent AF initiation in 153 of 229 cases. In 41% of cases of AF initiation the first atrial wave (A(1)) was closely related to ventricular activation (V) with V-A(1) interval of 94+/-5 ms (<> AF). This ventricular excitation induced acute short increase of RAP from 6.6.+/-0.6 to 12.9+/-1.1 mmHg (p<0.00l). Whereas other cases of AF initiation (59%) had no relation to ventricular activation (A(1)-V interval of 1382+/-173 ms) (<> AF). Atrial activation mapping (224 unipolar electrodes) showed that interval A(1)-A(2) of <> AF was significantly shorter than of <>. These data indicate that atrial stretch induced by elevation of RAP may facilitate the induction of AF but do not play a significant role in the mechanism of spontaneous AF initiation in this animal model.

We studied effects of a new class III antiarrhythmic drug RG-2 in a canine model of vagally-mediated atrial fibrillation (AF). RG-2 was intravenously infused to anesthetized open-chest dogs in progressive doses (5, 10, 20 and 40 mg/kg, n=6) during vagally-induced AF. RG-2 significantly dose-dependently increased atrial effective refractory period (AERP) with and without vagal stimulation, but did not change conduction velocity. Five mg/kg terminated vagally-induced AF in 4 of 6 dogs but did not prevent AF reinduction. However, additional doses of drug 20 and 40 mg/kg successfully terminated AF in 100% as well as prevented AF reinduction in 50% and 72% of cases, respectively. Activation mapping (224 epicardial electrodes) showed that under drug influence there was gradual reduction of wavelet number until termination of the reentrant excitation. AF cycle length increased before AF termination from 91+/-4 to 140+/-8 ms (p<0.01). These changes correlated with drug-induced increasing of AERP. In conclusion, the ability of RG-2 to terminate and prevent reinduction of experimental AF appears to be associated with a significant prolongation of the AERP.

Patterns of atrial activation of ectopic pulse source during vagal stimulation were studied on atrial epicardial surface and atrial septum in mongrel dogs. Epicardial activation maps were drafted. The findings show that, irrespective of preferred direction of conduction in the atria and septum, the entire atrial myocardium acted as a conducting system. Mapping of the first extrasystolic beats during tachyarrhythmias induced with vagal stimulation, has shown their ectopic origin. The data obtained confirms the suggestion that atrial fibrillation may be due to a single source of arrhythmia in septal area.

The clinico-experimental investigation has shown high efficiency of the bilateral subdiaphragmatic truncal vagotomy in treatment of patients with acute gastroduodenal ulcers complicated by massive hemorrhage. The haemostatic effect of the operation is related to the inhibited acid gastric secretion, proteolytic activity of the intragastric content as well as to the activation of serotonin-containing cells and increased tonus of the sympathetic nervous system, which is responsible for gastric vessel spasm, shortens time of bleeding, increases the amount of thrombocytes and their aggregation. When vagotomy with interventions draining the stomach is not possible, suturing (dissection) of bleeding acute ulcers is recommended in combination with prolonged novocain blockade of vagus nerves.

Forty-two patients with postgastroresection peptic ulcers of the zone of gastrojejunal anastomoses were examined. The cause of the appearance of the ulcers was the action of aggressive content of the gastric stump on the jejunum in the area of anastomosis. "Vagal" peptic ulcers were found by the gastrocepin test. After operations reducing the stump acidity healing of all the ulcers was noted. In achlorhydria of the stump the digestion in it is realized due to reflux at the expense of pancreas proteinases.

The modern methods of diagnosis were analysed in 19 patients with chemodectoma of vagal glomus verified surgically and morphologically. The cytological investigation of the tumour punctates was made in 9 patients, ultrasonic introscopy in 2, computer tomography in 13 and arteriography in 17 patients. The informativeness of cytological and ultrasonic studies is low, whereas computer tomography and carotid arteriography are regarded as the method of choice for diagnosis and assessment of vagal chemodectoma prevalence.

The authors provide the results of the treatment of patients with duodenal ulcers using common conservative therapy, local laser therapy and endoscopic denervation of the body of the stomach. Inclusion of endoscopic treatment methods into multimodality treatment brought about the enhancement of the treatment efficacy, more pronounced with endoscopic denervation.

The authors present the results of clinico-neurological study on 3976 patients suffering from diabetes with the use of electrophysiological, biochemical and other methods. As revealed, the sex of diabetic patients, particularly at definite age periods produced a significant influence on the time of occurrence and the rate of development of various types of the central and peripheral neuropathy. Thus, at the age of under 30 years almost all the types of diabetic neuropathy originated earlier and developed more rapidly in women, and after the age of 50 years some of these types of neuropathies were more frequent and more pronounced in men. No significant differences in the incidence of many types of diabetic neuropathy were revealed at the age of from 30 to 50 years both in men and in women. The mentioned regularity was most distinctly traced in analysis of distal pelyneuropathy. A hypothesis is put forward on the causes inducing peculiarities of the diabetic neuropathy development depending on the sex factor.

On the basis of the clinical examination of 99 patients, researchers distinguished the clinical forms of the glomus tumour of the temporal bone and of the base of the skull: glomus jugulare tumour, tympanic glomus, glomus of the pyramid of the temporal bone, glomus of the vagus nerve. Every clinical form is characterized both by general symptoms and by signs which appear only with the given form. The peculiarity of the clinical course of glomus tumours is due to intracranial growth, malignization and also by recurrence and prolonged growth.

Intravital biomicroscopy was used to study permeability and microcirculation of pulmonary vessels during experimental neuritis of the vagus nerve. The study lasted 14 days. Vascular permeability was evaluated from the changes in adhesion capacity of capillary endothelium with respect to India ink. The microhemodynamics was explored by visual observation and appraisal of the photo and film documents. The most pronounced changes were noticed on the 3d day. In the following days the changes were phasic in nature, repeating on days 6, 9 and 12. All the changes were synchronous.

Under study were the neurons of the cerebellum cortex of adult cats after a right-side transection of the vagus nerve cranially to its ganglion. The neuron structure was studied in frontal 10-20 mu thick paraffin sections stained with thionine after Nissl 1, 2, 10, 20 days and 1, 2, 3 months after operation. Pathomorphological alterations of neurons were revealed in all layers of the cerebellum cortex. The alterations were of bilateral character, but were more pronounced in the operation side.

Results of many-year studies and literary data on the clinical course, pathogenesis and pathogenetic therapy of motor, sensor, and vegetotrophic disturbances in the facial region are reviewed. A concept is substantiated, that neuralgia of the trigeminal, glossopharyngeal and vagal nerves, secondary contracture of the mimic muscles, and facial hemiatrophy are diseases with a specific pathogenesis having no analogy with pain, motor, and trophic disturbances in other parts of the body. This is reflected in the special methods of the pathogenetic therapy of the diseases.

On the basis of analyzing 800 observations on patients with neuralgias and prosopalgias, the authors identify special or paroxysmal neuralgias of the tunnel origin that are marked by a pathognomic clinical picture and require specific therapy. Another group of facial pains--prosopalgias proper--includes pains varying in the origin, clinical course and therapeutic approach. Diagnostic terms for describing neuralgias of the trigeminal nerve are reviewed, and the concept of their primarily central or primarily peripheral origin is proved to be untenable.

Two cases with a rare glomus tumor, chemodectoma of the vagus nerve on the neck, are described. On the basis of these cases and the data in the literature the clinical picture and methods of surgical treatment are discussed.