Autonomic nervous system of the pelvis is still poorly understood. Every year more and more pelvic procedures are carried out on patients suff ering from diff erent pelvic disorders what leads to numerous pelvic dysfunctions. Authors tried to review, starting from historical and clinical background, the most important reports on anatomy of the pelvic autonomic plexuses. We also pay attention to complete lack of knowledge of students of medicine on the autonomic nervous structures in the area studied. We present anatomical description of the pelvic plexuses including their visceral branches and anatomy of surrounding pelvic tissues which still remains unclear. More and more attention is paid to the topography of the plexuses specially because of new pain releasing techniques — neurolysies.
I n t r o d u c t i o n: Stress is an ubiquitous phenomenon in the modern world and one of the major risk factors for cardiovascular disease. Th e aim of our study was to evaluate the effect of various acute stress stimuli on autonomic nervous system (ANS) activity, assessed on the basis of heart rate (HRV) and blood pressure (BPV) variability analysis.
Ma t e r i a l s a n d M e t h o d s: The study included 15 healthy volunteers: 9 women, 6 men aged 20– 30 years (23.3 ± 1.8). ANS activity was assessed by HRV and BPV measurement using Task Force Monitor 3040 (CNSystems, Austria). ECG registration and Blood Pressure (BP) measurement was done 10 minutes at rest, 10 minutes aft er the stress stimulus (sound signal, acoustic startle, frequency 1100 Hz, duration 0.5 sec, at the intensity 95 dB) and 10 minutes aft er the cold pressor test. The cold pressor test (CPT) was done by placing the person’s hand by wrist in ice water (0–4°C) for 120 s.
R e s u l t s: Every kind of stress stimulation (acoustic startle; the CPT) caused changes of HRV indicator values. The time domain HRV analysis parameters (pNN50, RMSSD) decreased aft er acoustic stress and the CPT, but were signifi cantly lower after the CPT. In frequency domain HRV analysis, significant differences were observed only aft er the CPT: (LF-RRI 921.23 ms2 vs. 700.09 ms2; p = 0.009 and HF-RRI 820.75 ms2 vs. 659.52 ms2; p = 0.002). The decrease of LF-RRI and HF-RRI value aft er the CPT was significantly higher than after the acoustic startle (LF-RRI 34% vs. 0.4%, p = 0.022; HF-RRI 19.7% vs. 7% ms2, p = 0.011). The decreased value of the LF and HF components of HRV analysis are indicative of sympathetic activation. Nonlinear analysis of HRV indicated a significant decrease in the Poincare plot SD1 (p = 0.039) and an increase of DFAα2 (p = 0.001) in response to the CPT stress stimulation. Th e systolic BPV parameter LF/HF-sBP increased signifi cantly aft er the CPT (2.84 vs. 3.31; p = 0.019) and was higher than aft er the acoustic startle (3.31 vs. 3.06; p = 0.035). Signifi cantly higher values of diastolic BP (67.17 ± 8.10 vs. 69.65 ± 9.94 mmHg, p = 0.038) and median BP (83.39 ± 8.65 vs. 85.30 ± 10.20 mmHg, p = 0.039) were observed in the CPT group than in the acoustic startle group.
C on c l u s i o n s: Th e Cold Pressor Test has a greater stimulatory eff ect on the sympathetic autonomic system in comparison to the unexpected acoustic startle stress. Regardless of whether the stimulation originates from the central nervous system (acoustic startle) or the peripheral nervous system (CPT), the final response is demonstrated by an increase in the low frequency components of blood pressure variability and a decrease in the low and high frequency components of heart rate variability.
Alcohol is a recognized teratogen that affects various aspects of fetal development. Tissue that is particularly susceptible to its teratogenicity is neuronal tissue. The effect of prenatal alcohol exposure (PAE) on the central nervous system has been extensively studied, yet the knowledge on the influence of PAE on the autonomic nervous system is scarce. The purpose of this article is to review the current state of knowledge about the impact of PAE on the autonomic nervous system. Studies conducted on the PAE animal model have shown that prenatal alcohol exposure is associated with significant alterations in the autonomic nervous system, but the mechanisms and consequences are not yet clearly defined. It was established that PAE causes decreased heart rate variability (HRV) in fetal cardiotocography. Several studies have revealed that later, in infancy and childhood, reduced parasympathetic activity with or without compensating sympathetic activity is observed. This may result in behavioral and attention disorders, as well as an increased predisposition to sudden infant death syndrome. Both animal and human studies indicate that the relationship between PAE and autonomic dysfunction exists, however large, well-designed, prospective studies are needed to confirm the causal relationship and characterize the nature of the observed changes.