Neurotrophic Disorders Research Articles

Nervous system functioning disorders in patients with mandible fractures

Relevance. Fractures of the mandibular fracture are a stressor on the body and lead to changes in the functioning of the autonomic nervous system. At the same time, patients with mandibular fractures often experience local changes in the nervous system associated with the anatomical and physiological features of the location of the third branch of the trigeminal nerve and its damage. These changes affect the course of the post-traumatic period and may increase the likelihood of complications of mandibular fractures.Purpose: to determine the significance of disturbances in the functioning of the nervous system during the post-traumatic period of fractures of the mandibular fracture.Materials and methods. When examining 130 patients with fractures of the mandibular fracture, the state of the autonomic nervous system and local neurological changes were studied.Results. In patients with mandibular fractures, dysfunction of the autonomic (autonomic) nervous system and local neurological changes were revealed.The severity of these changes is reflected in the development of complications of fractures. When studying the autonomic nervous system in patients with mandibular fractures, there was an increase in the activity of the sympathetic nervous system, which increased the likelihood of developing complications of mandibular fractures. A high incidence of injury to the inferior alveolar nerve was also found. The most pronounced deviations in autonomic balance indicators – pathological increased excitability of the autonomic nervous system – were diagnosed in patients with complicated fractures of the mandibular fractures. In most patients with complicated mandibular fractures, damage to the trigeminal nerve was detected, confirming the role of neurotrophic disorders in the development of complications.Conclusion. With fractures of the mandible, there is an increase in the activity of the sympathetic nervous system, which increases the likelihood of complications. The most pronounced deviations in autonomic balance indicators were diagnosed in patients with complicated fractures of the mandible. In addition, in patients with mandibular fractures, a high incidence of damage to the inferior alveolar nerve was revealed; in complicated fractures, neuropathy is severe, which confirms the role of neurotrophic disorders in the development of complications. Thus, methods for preventing purulent-inflammatory complications in jaw fractures should include correction of neurological disorders.

Исследование влияния факоэмульсификации возрастной катаракты на слезопродукцию и морфометрические параметры роговицы

Purpose. To study the effect of phacoemulsification (PE) of age-related cataract (ARC) on tear production (TP) and morphometric parameters of the cornea. Material and methods. 120 patients (120 eyes) aged 62 to 83 years after ARC PE were examined. All patients were divided into 2 groups according to the level of TP: 1st group – 60 patients with normal and slightly reduced TP, 2nd group – 60 patients with moderate and severe suppression of TP. In addition to standard research methods, all patients underwent the Schirmer-1 test, OCT-scanning of the cornea, also tear break-up time (TBUT), endothelial cell density (ECD) (initially, the next day after surgery, then on the 10th, 20th and 30th days) were analyzed. Results. The indices of TBUT, corneal epithelium thickness (CEC), corneal stromal thickness (CST) and ECD in the eyes of patients of the second group were lower than in the eyes with normal TP. Conclusion. The analysis showed that in patients with a moderate and severe decrease in TP, postoperative changes in CEC occur 4 times more often, and CST – 1.5 times more often than in eyes with normal TP. At the final stage of treatment, the recovery of CEC in the eyes of patients in the second group of the study was observed 2.6 times less than in the eyes of patients in the first group, which may indicate the possible presence of neurotrophic disorders in the cornea in patients with reduced TP. Keywords: age-related cataract, phacoemulsification, tear production, corneal epithelium thickness, corneal stroma thickness

Clinical Application of the Classical Theory of Traditional Chinese Medicine in Diabetic Nephropathy.

Objective To explore the clinical application of the classical theory of traditional Chinese medicine (TCM) in diabetic nephropathy (DN). Methods A total of 100 patients with DN treated in our hospital from May 2019 to June 2021 were included. The patients were randomly assigned to the control group and the study group. The control group received routine treatment, and the study group was treated with the classical theory of TCM. The efficacy, TCM syndrome score, urine proteinuria (UTP), urine albumin-creatinine ratio (UACR), plasma albumin (ALB), hemoglobin A1c (HbA1C), fasting blood glucose (FBG), blood urea nitrogen (BUN), creatinine (Cr), and treatment safety were compared between the two groups. Results In comparison to the curative effect, the study group was significantly effective in 34 cases, effective in 12 cases, and ineffective in 4 cases, and the effective rate was 92.00%; the control group was significantly effective in 16 cases, effective in 18 cases, and ineffective in 16 cases, and the effective rate was 68.00%. The effective rate in the study group was higher compared to the control (P < 0.05). In comparison to the TCM syndrome scores, there exhibited no significant difference before treatment (P > 0.05), but after treatment, the TCM syndrome scores of the two groups decreased, and the TCM syndrome scores of the study group were lower compared to the control at 6 weeks, 12 weeks, 24 weeks, and 36 weeks of treatment (P < 0.05). There exhibited no significant difference in the indexes of UTP and UACR before treatment, but the indexes of UTP and UACR in the two groups decreased after treatment, and the indexes of UTP and UACR in the study group were lower compared to the control at 6 and 12 weeks after treatment. There was no significant difference in the indexes of ALB, HbA1C, and FBG before treatment, but after treatment, the indexes of ALB increased, the indexes of HbA1C and FBG decreased in both groups, and the indexes of HbA1C and FBG i4n the study group were lower compared to the control, while the index of ALB in the study group was higher. The indexes of BUN and Cr were compared, and there was no significant difference before treatment, but after treatment, the indexes of BUN and Cr in the two groups decreased, and the indexes of BUN and Cr in the study group were lower compared to the control (P < 0.05). In terms of the treatment safety of the two groups, there was no abnormality in blood, urine, stool routine, and liver and kidney function examination in the study group. No obvious adverse reactions were found in all patients. There were 1 case of abnormal liver function and 2 cases of rash in the control group, and there exhibited no significant difference (P > 0.05). Conclusion Under the guidance of classical theory, the optimization scheme of comprehensive treatment of TCM may improve renal function by improving metabolic disorders, vascular lesions, neurotrophic disorders, antioxidant stress, and other ways to repair nerve injury, improving the changes of TCM syndromes, signs, and indicators of patients, and delay the progress of DN.

Successful application of conditioned culture medium for the treatment of a chronic wound of an amputation stump: a clinical case

Background: Amputation of the lower extremities is a necessary procedure to save a patient with critical arterial and neurotrophic disorders in the lower extremities. The amputation stump-related complications develop in many patients with diabetes mellitus (up to 40% of the total population).&#x0D; Clinical case description: Patient Yu., 64 years old, was admitted on October 19, 21 for an outpatient treatment of purulent-necrotic wounds of the amputation stump of the right lower limb. А high amputation was performed on September 24, 2021 due to thrombosis of the femoral-tibial bypass, installed on September 08, 2021 (bypassing below the knee joint gap with a Vascutek 7 mm synthetic prosthesis on the right) and the development of critical ischemia of the right lower limb with necrosis of the distal phalanges of the right foot toes. The wound was assessed according to the Bates-Jensen scale (BJ) and examined according to the developed protocol. The wound treatment was carried out according to an individual plan using a conditioned culture medium from mesenchymal stem cells (CM-MSCs), which stimulates angiogenesis and improves remodeling and recovery in the wound area. CM-MSC application made it possible to reduce the healing time and achieve a scarless closure of the tissue defect.&#x0D; Conclusion: The use of CM-MSC can be an effective method for healing a purulent-necrotic postoperative wound resulting from amputation of a limb in patients with critical ischemia of the lower extremities.

Modern aspects of the treatment of post-traumatic deforming arthrosis of the ankle joint

Post-traumatic deforming arthrosis of the ankle joint is a severe complication of damage to articular structures. The severity of its clinical manifestations depends on a number of factors: the time elapsed since the injury, the severity of primary anatomical disorders, the activity of reparative processes, the presence of tibiofibular diastasis, the state of the ligamentous apparatus, paraarticular tissues, and neurotrophic disorders.

Застосування тест-ортезів на нижні кінцівки для визначення фізичних можливостей та реабілітаційного потенціалу осіб із тяжкими порушеннями функції опори й ходьби

Застосування тест-ортезів на нижні кінцівки для визначення фізичних можливостей та реабілітаційного потенціалу осіб із тяжкими порушеннями функції опори й ходьби

The Ilizarov technique in treating denervated ankle-foot deformities

Background:Neurological injuries or diseases may cause ankle-foot deformities that seriously affect patients’ quality of life.Objective:This study aimed to explore the feasibility of the Ilizarov technique for treating complex ankle-foot deformity with neurotrophic disorders.Methods:In this retrospective study, 10 patients, including 6 males and 4 females, with complex ankle-foot deformities with nerve injury were treated from January 2014 to May 2019. The age of the patients ranged from 13 to 57 years with an average of 27.9 years. The reasons of nerve injury were as follows: sequelae of spina bifida in five patients, post-traumatic injury of the common peroneal nerve and tibial nerve in four patients, and subacute degeneration of the spinal cord in one patient. Minimally invasive surgery was used for osteotomy, muscle strength balance, and external ring frame fixation, and various deformities were gradually corrected after the operation. The ankle- foot function was evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score before surgery and at long-term follow-up after surgery.Results: All 10 patients were followed up for 12 months to 3 years, with an average of 1.9 years. The deformities of all 10 patients were corrected; and of the 10 patients, three partially recovered their nerve function. A significant difference (p &lt; 0.001) between the AOFAS score (81.6 ± 10.45) evaluated in the long-term follow-up and that evaluated preoperatively (31.1 ± 14.69). The AOFAS comprehensive score was excellent in two patients, good in six patients, and fair in two patients.Conclusion:The Ilizarov technique combined with minimally invasive osteotomy and muscle strength balance could safely correct complex ankle-foot deformities with neurotrophic disorders.

Тригеминальный трофический синдром

Trigeminal trophic syndrome is a rare nosological pathology form of the face. Based on the literature data and 11 own observations, the article discusses the pathogenesis, diagnosis and treatment of skin sensations, ulcerative and other cosmetic defects that occur after injury of the peripheral branches, Gasser's node, root, and the upper sensitive trigeminal nerve nucleus in the dorsolateral part of the pons Varolii upper section in the brain stem. The clinical disease manifestations are described in detail with the characteristics of the lesions, their localization, course dynamics, and mental status patterns of patients. The article presents a detailed list of pathological conditions with which trigeminal trophic syndrome should be differentiated (malignant epithelioma, mycoses, focal fibrosing alopecia, leprosy, syphilis, diabetes mellitus, cutaneous manifestations in diseases of internal organs and connective tissue (scleroderma, temporal arteritis, Wegener's granulomatosis), central and peripheral nervous system, substance abuse, psychosomatic disorders, somatopsychosis, autoaggression, Munchausen syndrome, etc.). KEYWORDS: skin ulcers, neurotrophic disorders, trigeminal trophic syndrome, deafferentation, iatrogenic complications. FOR CITATION: Belopasov V.V. Trigeminal trophic syndrome. Russian Medical Inquiry. 2020;4(9):566–572. DOI: 10.32364/2587-6821-2020- 4-9-566-572.

Pathomorphology of the cerebral cortex of cats for infectious peritonitis

The article presents the results of histological studies of the frontal area of the cerebral cortexб taken from 10 corpses of cats aged from 3 months to 5.5 years, in which infectious peritonitis (based on anamnesis, clinical signs, morphological and biochemical blood analysis , ultrasound diagnostics, Rivalt test and express diagnosis) was diagnosed during their life. A pathoanatomical study was conducted; samples of the frontal area of the cerebral cortex of cats, which were fixed in a 12% aqueous solution of neutral formalin, a solution of Carnoua and 96° ethyl alcohol, were selected. The histocuts were made, which were stained with hematoxylin and eosin, thionine for Nisslem. In order to detect the astrocytic glory, a fraction of the cerebral cortex was fixed by the Golgi-Clatzo method with a fresh mixture of chloral hydrate-formalin-bichromate and produced histocuts on a freezing microtome. For histological examination of the cerebral cortex of cats, changes in the non-inflammatory character were observed, which were characterized by disorders of hemomycrocycle circulation, edema and degenerative processes of the neuroglial complex and neurons. Violations of the structural organization of endothelial cells, basal membranes of capillaries and venules should be considered as an important indicator of functional changes in tone, permeability of the microcirculatory channel, which contributed to the development of perivascular and pericellular edema, which in its turn led to regressive changes of glial elements; acute swelling of neurons with the formation of microcavities in nuclei; a sharp decrease in the content of the chromatophilic substance in pyramidal and stellate cells; the development of gidropic dystrophy in star cells and creatures; rise of shadow cells. Circulatory disorders caused the violation of the trophic transport systems, which caused hypoxia, accumulation of acidic metabolism products, and formed the basis for the pathogenesis of the development of dyscirculatory dystrophy of neuroglial cells and neurons, i.e. neurotrophic disorders of the cerebral cortex of cats for FIR.

Current concepts of maxillitis pathogenesis and morphogenesis

The aetiology of prenatal sinusitis as well as maxillitis is caused by bacteria, micromyces and viruses, often in combination. Acute infection spreads predominantly from meatus to paranasal sinuses resulting in rhinosinusitis development. Natural sinus fistula obstruction due to mucous membrane oedema, endotoxicosis, disorders of tissue immunity and mucociliary clearance, leukocytic infiltration, stimulation of oxygen active forms formation in leukocytes etc. are significant for the disease pathogenesis. As a result, inflammatory and dystrophic changes develop in all layers of sinus walls. The pathological process is affected by a number of confounding factors. The aim of the research is to study the recent research publications for better comprehension of the main factors of maxillitis aetiology and pathogenesis taking into account our research data. Conclusions. Maxillitis is caused by pathogenic and potentially pathogenic bacteria, fungi and viruses, which are usually spread to sinuses from meatus. Endotoxicosis, the decrease in tissue immunity and mucociliary clearance, inflammatory and dystrophic changes in mucosae and bone layer of sinus walls are very important for the pathogenesis. The significance of neurotrophic disorders is proven. The confounding factors take account of immunodeficiency, cryoglobulinemia, sinus fistula obstruction, adenoidal vegetation, anatomical anomalies of nose, hepatic insufficiency.

Некоторые особенности показателей электронейромиографии и денситометрии у пациентов с остеохондрозом шейного отдела позвоночника

Manifestations of cervical osteochondrosis are largely predetermined by degenerative changes in the most mobile lower cervical spine (C V -C VI , C VI -C VII ). Clinical picture of cervical osteochondrosis depends not so much on the presence of hernial protrusions as on the changes in bone structures with the formation of arthrosis with pain syndrome. In this regard, we found interesting to study relation of electroneuromyographic parameters and bone mineral density in patients with cervical osteochondrosis. A survey of 38 patients with cervical osteochondrosis localized predominantly in the segments C III -C IV , C IV -C V , C V -C VI C VI -C VII there were 20 men and 18 women. Subjective and objective examinations showed pronounced muscular-tonic syndrome (with cervicalgia, cervicocranygia, cervicobrachialgia) in all patients. We studied threshold values, M-response amplitude, nerve conduction in motor fibers of the axillary, radial, medial and ulnar nerves, as well as amplitude and frequency indices characterizing the functional state of the deltoid and trapezius muscles. When studying the state of bone tissue, we measured the speed of sound velocity (SV, m/sec) in the radial bones, determined the T-index - the number of standard deviations from mean for healthy young people, and the Z-index - the number of standard deviationsfrom mean for the age group. Comparative analysis of the results of studies by electroneuromyography and osteodensitometry in patients with cervical osteochondrosis of I-II periods, in the presence of neurotrophic disorders have not revealed changes in bone density. At the same time, in patients with cervical osteochondrosis of the III period in the presence of both protrusions and hernias of C VI -C VII C VII -C VIII discs, a reduction in threshold values of direct muscle response, an increase in the amplitude of evoked potentials, and a shortening of the latent period were recorded in the ENMG. Mineral density in patients with this pathology differed from the norm, indicating the presence of osteopenia.

FK962 induces neurite outgrowth in cultured monkey trigeminal ganglion cells.

Corneal sensation, cell proliferation, and wound healing all depend on adequate corneal innervation. Disruption of corneal innervation can lead to dry eye and delayed wound healing. Our studies in rats and rabbits show that the substituted fluorobenzamide drug FK962 accelerates the extension of neuronal processes and recovery of corneal sensitivity. The purpose of the present study was 1) to determine whether FK962 induces sprouting and elongation of neurites in cultured monkey trigeminal ganglion cells, and 2) to investigate the involvement of the neurotrophic peptide GDNF in FK962-induced neurite elongation. Dissociated, cultured trigeminal ganglion cells, containing neuronal and Schwann cells were cultured for 48h with or without FK962. Neuronal elongation was evaluated by immunostaining with a neurofilament-specific antibody. Culture with or without GDNF, or with antibody against GDNF, was used to determine the role of GDNF in FK962-induced neurite elongation. FK962 or GDNF were found to significantly induce neurite elongation. The GDNF antibody significantly inhibited elongation induced by FK962. GDNF was found to be a mediator of FK962-induced neurite elongation in a relevant primate model. FK962 may be a candidate drug for treatment of neurotrophic disorders in the human cornea.

FEATURES OF CONGENITAL PSEUDARTHROSIS OF THE TIBIA OF DYSPLASTIC AND NEURODYSTROFIC GENESIS

The purpose of study was to refine frequency of etiological factors and characteristics of congenital pseudarthrosis of tibia (CPT). Materials and Methods. The analysis of complex research (anamnestic, clinical, radiological, physiological, morphological) of 190 patients with CPT. Results. It was found that the causes of disease are: neurofibromatosis, myelodysplasia and fibrous dysplasia. In neurofibromatosis and myelodysplasia in the basis for false joints there are neurotrophic disorders. Typically a latent pseudarthrosis occurs at birth with the progression of deformity and thinning of the affected bone. Provoking factor of pseudarthrosis is a pathological fracture. Deformities, limb shortening, significant thinning and sclerosis of ends of bone fragments, degenerative changes in bone tissue throughout the diaphysis and epiphysis, lowered bone growth, weak ossification at the ends of bone fragments up to complete absence are observed. In fibrous dysplasia the provoking factor is a pathological fracture. The ends of the bone fragments are thickened, sclerotic, they reveal foci of fibrous dysplasia. Conclusion. It was found that two groups of CPT are: neurotrophic and dysplastic types. Neurotrophic CPT develops against neurofibromatosis and myelodysplasia, dysplasric one - against fibrous dysplasia. Features of the development and course of congenital pseudarthrosis of tibia have a direct correlation with the etiologic factor.

Гострі нейротрофічні порушення органів травної системи при церебральних інсультах

У статті наведено клінічні випадки виникнення гострих нейротрофічних порушень системи травлення при гострих церебральних інсультах. З огляду на отримані анамнестичні, клінічні, лабораторно-інструментальні дані можна прогнозувати ймовірність виникнення гострих ускладнень основного захворювання.

Wavelet Analysis of Skin Perfusion in Healthy Volunteers

Rhythmical changes in microvascular perfusion of the skin depend on various influences, which appear continuously but not in a predictable manner. For identifying and quantifying different physiological influences the authors used wavelet transformation, analyzing continuously and simultaneously measured data. A total of 34 healthy volunteers were included in the study. At the dorsum of the left hand, skin perfusion was measured by laser Doppler fluxmetry (LDF) and skin temperature was measured. Simultaneously, the electrocardiogram and the respiration were recorded. The recorded time series were analyzed with wavelet transformation and scale correlation (S-correlation). Semilinear analysis with wavelet transformation allowed a visualization of temporal changes in LDF frequency and amplitude in a color-coded quasi three-dimensional diagram. The authors found that tissue perfusion over an observation period of 327.68 s is governed by 6 closely connected, overlying waves with different degrees of freedom. The major determinants are low frequencies in LDF, which correlates with changes in skin temperature, responsible for 68.5% of the influence. Surprisingly, though indispensable for blood flow, respiration and heartbeat contributed to less then 2.5% of the rhythmic changes. When wavelet transformation is used in analyzing LDF time series, the different rhythms of cutaneous blood flow are made visible and quantifiable and can be assigned to different physiological origins. The application of this novel analysis method allows identifying mechanisms regulating skin perfusion, which will greatly facilitate the diagnosis of a variety of important vascular diseases, such as chronic venous insufficiency, diabetes, or neurotrophic disorders.

Neurophysiological mechanisms of neurological disorders in people irradiated in the Chernobyl’ catastrophe

We analyzed shifts in the functional parameters of the autonomic and segmental somatic reflex mechanisms in various categories of people subjected to irradiation because of the catastrophe at the Chernobyl’ NPS. It is demonstrated that long-lasting irradiation even with mild intensity evokes serious damage to the central structures controlling autonomic functions (first of all, the hypothalamus). This results in the development of autonomic dysfunction with domination of disorders of the sympathetic system manifested in a dramatic drop in the amplitude, an increase in the duration, and modification of the phase structure of evoked autonomic skin responses in all examined groups of persons. Cardiovascular and neurotrophic disorders are crucial factors, which determine pathological modifications in the somatic reflex sphere (a drop in the amplitude of sensory evoked potentials and a decrease of the conduction velocity in the peripheral nerves, a drop in the amplitude of M responses in the limb muscles, but with relatively small shifts in the synaptic relays of segmental reflex arcs).

State of the autonomic reflex mechanisms in humans subjected to irradiation because of the Chernobyl' catastrophe

People affected by the catastrophe at the Chernobyl' Nuclear Power Station (ChNPS) were subjected to a detailed clinical neurological examination. In 328 examined individuals, sympathetic skin responses (SSR), evoked by transcutaneous stimulation of then. medianus, were recorded. These people were classified in the following groups: group I, people involved in the cleanup and repair after the catastrophe (henceforth called cleanup workers) who were subjected to relatively short-lasting, but high-intensity irradiation (the integral absorbed dose of 0.7–6.5 Gy) and suffered from acute radiation syndrome; group II, cleanup workers who received lower absorbed doses, but had worked at the NPS before the catastrophe and continued later to work within the excluded zone; group III, cleanup workers involved only in the work of 1986; group IV, foresters and woodcutters, who permanently live and work within the contamined territories; and group V, the people not involved in the work of 1986, but who worked for a long time within the excluded zone on rotating shifts. The latter group was subdivided into two subgroups: a, men; and b, women. Considerable SSR modifications were typical of all these groups. The amplitude of this potential sharply dropped, while its duration increased more than 1.5 times, on average. Both these parameters showed high individual variability, and the phase structure of SSR was noticeably modified in a considerable share of the examined people. At the same time, the SSR latencies showed no systematic shifts, as compared with those observed in the control group. The mean amplitudes of SSR recorded from the palms in groups I–IV and subgroups Va and Vb reached only 54, 27, 40, 47, 27, and 46% of the values measured in the control group, while those of SSR recorded from the soles was in groups I–IV of 22, 18, 23, and 31%. The data of neurological examination of the persons subjected to irradiation indicated an expressed pathology in the diencephalo-limbic structures; this pathology was manifested as an autonomic dysfunction with dominating symptoms of the injury of the sympathetic system. It is concluded that long-lasting influence of external and internal irradiation, even at its low intensity, results in serious impairments of the central structures providing control of autonomic functions (first of all, of the hypothalamus). These impairments lead to the development of cardiovascular and neurotrophic disorders and represent the most important factors that determine pathological shifts both in the autonomic and somatic reflex mechanisms.

Roentgenologic Changes in Malacic Diseases of Bone

THE past several years have witnessed the accumulation of a voluminous literature concerning malacic diseases of bone, particularly hyperpara-thyroidism. This was stimulated largely by the report of Mandl (1), in 1926, of a case of osteitis fibrosa cystica generalisata (von Recklinghausen's disease), in which the removal of a parathyroid adenoma was followed by prompt clinical improvement. Since that time, the existence of “hyper-parathyroidism” as a definite clinical entity has become well established. Because of the profound influence of the parathyroid glands on the fundamental metabolism of calcium, and probably of phosphorus, it is not surprising that the question of parathyroid function, as related to other forms of malacic disease of bones, the origin of which is supposedly known or unknown, has been seriously considered. Some enthusiastic investigators see in hyperparathyroidism a ready explanation for the cause of such conditions as osteitis deformans (Paget's disease), leontiasis ossea, ankylosing polyarthritis of Oppel, giant-cell tumor, multiple myeloma, and scleroderma. Others are less ready to accept such a broad application of the term “hyperparathyroidism.” Because of such conflicting opinions, no little confusion has resulted, particularly in the minds of roent-genologists, concerning the identity of certain forms of malacic disease of bone. Without doubt, the present intensive clinical and investigative work that is being carried out on the subject of hyperparathyroidism and mineral metabolism in general will have a far-reaching effect on our knowledge and classification of certain lesions of bone. The problem is not an easy one, for it involves not only the intricate biochemistry of mineral metabolism, but also the function of the ductless glands and the complexities of their interrelated activities. With a full realization of this situation, the classification in Table I is offered, subject to revision. It does offer, at the present time, however, a reasonable basis for a discussion of the roentgenologic changes in the various forms of malacic diseases of bone. Because of the multiplicity of conditions that may affect the mineral content and structure of the skeleton, the early recognition of any particular disease by roentgenograms alone may be exceedingly difficult. Even in some advanced lesions, as will be pointed out subsequently, the ultimate diagnosis can be made only by proper correlation of the clinical data and other laboratory findings. Atrophy Atrophy of bone, which results from disuse incident to trauma, fracture, arthritis, neurotrophic disorders, or circulatory disease, is characterized by its limitation to the affected part.

Chemical way of distinguishing nerves (N. vagus from N. sympaticus)

In 1920, Prof. A.G. Molotkov proposed and introduced into the system, as a method, the transection of various abnormal nerves, mainly sensitive ones, in the composition of which, in his opinion, special trophic influences should take place. Having applied this method at the beginning for the treatment of such obviously neurotrophic disorders, which develop after traumatic injuries of various nerves in the form, for example, of a perforating heel ulcer, later on he extended it to various kinds of pathological processes not healing and not subject to any other treatment methods, such as varicose ulcers of the shin, spontaneous gangrene, panaric lesions, tubercular ulcers, malignant tumors, etc.