Decrease In Pulse Rate Research Articles

Impact of reduce the sleep disruption causes at post-operative ICU among patients after open Heart

Back ground Patients in ICU are experienced poor sleep quality and consistently report poor perceived sleep quality in ICU compared to home. Sleep disruption was the second most stressful condition reported by patients after open-heart surgery in ICU. Causes of sleep disruption at ICU are admission to ICU, separation from patients family, isolation, and fear of death, noise, light, extreme temperature , and diagnostic procedures, the patient being connected with many tubes, connection with machines, alarm of machines and monitors, and health team conversation. Existing evidence supports that ICU sleep promotion via multi-faceted interventions focused on minimization of nighttime sleep disruptions and maintenance of the homeostatic sleep-wake cycle. Therefore, the purpose of this study is reducing the causes of sleep disruption in ICU to improve patients sleep quality, and reduce complications. Patient and Method Quiz Experimental research design was used to conduct this research .This study was carried out at post-operative ICU in Assiut University Hospitals .The sample of this study was consisted of 40 patients, admitted to ICU after open-heart surgery. Tools used in this study are, First Tool: Patient's profile assessment sheet. Second Tool:1- sleep quality assessment questionnaire.2- Sleep disruption scale after open-heart surgery as a non-physiological assessment. Results: patients after open-heart surgery in ICU report poor sleep quality (1.5 ± 0.6) compared to home (9.9 ± 0.3).There is a significance increase (P<0.001) regarding to the overall quality of sleep in ICU stay for both groups. Highly significant decrease in overall degree of daytime sleepiness during ICU stay (p=0.000). Highly significant decrease in pulse rate of the study group (83.3 ± 10.7) versus control group (109.1 ± 14.8) through ICU says. Highly significant decrease in respiratory rate in 2nd day in ICU and poor significant differences in last day. Regarding to Systolic blood pressure there is statistical significant differences (p=0.003) in the2nd day. Regarding to length of ICU stay, there were highly significant decreased in study group versus control group (3.1 ± 0.3& 4.8 ± 1.1) day. Conclusion applying standard interventions to reduce sleep disruption causes in ICU was more effective to reduce complications of sleep disruption after open-heart surgery in study group versus control group who received routine hospital care. Recommendations: Patient preparation and provision of information should start from time of the surgeon's decision that surgery is required.

Systematic Review of Effects of Adenotonsillectomy on Cardiovascular Parameters in Children with Obstructive Sleep Apnea

To systematically review current studies on the effects of adenotonsillectomy (T&A) for obstructive sleep apnea (OSA) on cardiovascular parameters in children. PubMed database. A comprehensive PubMed MeSH search was done between 1970 and 2012. Fourteen articles were included. The total number of children was 418. The mean sample size was 30 (range, 1-62), and the mean age of the sample population was 6 years (range, 2-10 years). Criteria used for the diagnosis of OSA ranged from full-night polysomnography (PSG) to clinical parameters. Three studies had results from preoperative and postoperative PSG. Cardiovascular parameters studied included blood pressure, heart rate, cardiac morphology, and cardiac function. All studies reported an improvement in cardiovascular parameters and OSA symptoms after surgery. Three studies reported improvement in blood pressure, 6 reported improvement in mean pulmonary artery pressures, 7 reported improvement in echocardiographic findings, and 1 reported a decrease in pulse rate and pulse rate variability after T&A for OSA. There is evidence that cardiovascular morbidities associated with OSA are potentially reversible. T&A may have a significant role in reversing the cardiovascular sequelae of OSA. However, there is a paucity of well-designed and powered studies to address this issue.

Ephedrine accelerates psychomotor recovery from anesthesia in macaque monkeys

Ephedrine is used in treatment of hypotension during anesthesia. We investigated its effects on the psychomotor recovery and its potential adverse reactions on cardiorespiratory functions in rhesus monkeys. The monkeys received 50 μg/kg medetomidine, 2.0 mg/kg S-ketamine with 150 IU hyaluronidase i.m. Pulse rate, blood pressure and saturation of haemoglobin were monitored for 20 minutes. Thereafter, 1 mg/kg of ephedrine or a placebo was administered i.m. and behavioural changes, pulse rate, blood pressure and saturation of haemoglobin were monitored every 5 minutes. Ephedrine shortened recovery from anaesthesia from 80.4 ± 25.8 to 14.83 ± 13.70 minutes. Ephedrine also increased oxygen saturation of haemoglobin and systolic blood pressure and caused significant decrease in pulse rate 5 minutes after its administration. Ephedrine can be successfully used to accelerate psychomotor recovery after the use of common anesthetic protocols combining dissociative anesthetic agent and alpha 2-adrenoceptor agonist in primates.

Effect of Copper, Manganese and Zinc With Antioxidant Vitamins on Pulse Rate and Lipid Profile of Salt-Loaded Albino Rats

Hypertension and dyslipidemia are associated with oxidative stress and are major causes of cardiovascular diseases amounting to 30% of global death rate. The effect of antioxidants supplementation on pulse rate and lipid profile in salt-loaded albino rats were investigated using a randomized control study with 30 albino rats divided into 5 experimental groups of 6 rats each. Groups 1 and 2 were normal untreated and salt-induced untreated respectively. Groups 3-5 were treated with Vitamins (A, C and E) with Cu, Mn and Zn respectively. Hypertension and dyslipidemia were induced using Salt-loading method (8% NaCl) for a period of five (5) weeks where Group 1 received normal rat feed and Groups 2-5 received salt-loaded diet. The heart rate of the rats was measured before and after the salt loading and dyslipidaemia was assessed at the end of the experiment. The results indicated that salt loading induced significant increase (p<0.05) in pulse rate, total cholesterol (TC) and LDLcholesterol. It also induced significant (p<0.05) decrease in HDL-cholesterol and no change in Angiotensin converting enzyme activity. Treatment with antioxidants caused significant (p<0.05) decrease in pulse rate, TC and LDL-cholesterol and significant increase (p<0.05) in HDL-cholesterol even in the presence of the salt. There is no significant difference between treatments with the various elements. The results of the current study may therefore suggest that antioxidants supplementations may delay or reverse the onset of dyslipidaemia and hypertension associated with high salt diets in rats.

A Randomized, Double‐blind, Placebo‐controlled Study to Evaluate the Efficacy and Tolerability of Fufang Danshen (Salvia miltiorrhiza) as Add‐on Antihypertensive Therapy in Taiwanese Patients with Uncontrolled Hypertension

Hypertension generally requires the use of a combination therapy to achieve the satisfactory control of blood pressure. A traditional Chinese herb, Danshen (Salvia miltiorrhiza), has been shown to have cardioprotective effects in animals and humans. The study investigated the add-on effect of Fufang Danshen extract capsule in Taiwanese hypertensive patients with uncontrolled blood pressure. This was a double-blind, placebo-controlled, randomized, single-center study clinical trial. Fifty-five patients with uncontrolled mild to moderate hypertension were enrolled under current conventional antihypertensive treatment, randomized equally to receive a Fufang Danshen capsule (formula mixture) 1000 mg twice-daily or a placebo capsule for 12 weeks. Primary endpoints were the control rate and the response rate. By ITT analysis at week 12, the control rates were 25.5% in the Fufang Danshen group and 7.3% in the control group (p = 0.016). The response rates were 45.6% in the Fufang Danshen group and 38.2% in the placebo group (p = 0.946). A significant reduction of systolic blood pressure at week 12 was noted in the Fufang Danshen group compared with the placebo group (13.8 vs 4.2 mmHg, p = 0.005). A decrease of pulse rate was also noted in the Fufang Danshen group (- 3.2 vs +2.7/min, p = 0.027). Adverse events were not statistically different between the two groups. It was concluded that Fufang Danshen (Salvia miltiorrhiza) extract reduced systolic blood pressure and pulse rate, and was well tolerated in patients with hypertension.

The Enhanced Effect of Atenolol on Hypertension in Metabolic Syndrome

In metabolic syndrome, hypertension has been noted as one of the most important risk factors that contributes to cardiovascular disease. We have evaluated the effect of a selective adrenergic β(1)-receptor blocker, atenolol, on blood pressure and pulse rate in metabolic syndrome. Metabolic syndrome patients with hypertension (n=28) and a control group (n=20) were given atenolol (50 mg/day) for 4 weeks. Blood pressure, pulse rate, and blood biochemical parameters were monitored. Pulse rate in the metabolic syndrome group before the treatment was significantly higher than in the control group (control 74 ± 2/min, metabolic syndrome 84 ± 2/min, P<0.05). Decrease in pulse rate resulting from the treatment was greater in the metabolic syndrome group than in the control group (control 14 ± 3/min, metabolic syndrome 21 ± 2/min, P<0.05). Decrease in systolic (SBP) and diastolic (DBP) blood pressure was greater in the metabolic syndrome group than in the control group (SBP, control 8 ± 3, metabolic syndrome 23 ± 3 mmHg, P<0.05; DBP, control 6 ± 3, metabolic syndrome 13 ± 2 mmHg, P<0.05). There was a positive association between decrease in SBP and the waist measurements of patients, between the decrease in DBP and the waist measurements, and between the decrease in pulse rate and the waist measurements. We also found that there was a positive association between the decrease in SBP and initial SBP, between the decrease in DBP and initial DBP, and between the decrease in pulse rate and initial pulse rate. These data showed that atenolol has an enhanced effect on blood pressure and on pulse rate in metabolic syndrome. It may be useful in treating severe hypertension with elevated heart rate in metabolic syndrome.

Ambulatory laparoscopic tubal ligation: A comparison of general anaesthesia with local anaesthesia and sedation

To compare the anaesthetic techniques for laparoscopic tubal ligation using either general anaesthesia with LMA or a combination of local anaesthetic and intravenous sedation, this study was conducted on 60 ASA-1/2 patients in the age group of 20-40 years. PATIENTS #ENTITYSTARTX00026; 60 ASA grade I & II female patients undergoing laparoscopic tubal ligation on a day care basis were randomly divided in two groups- group I (GA using LMA, n=30), group II (Local anaesthesia, n=30). Both groups received similar premedication. General anaesthesia in group I was induced with propofol 2-3 mg kg(-1) and following LMA insertion, the anaesthesia was maintained with 0.5-1.5% halothane. In group II the incision site was infiltrated with 10 ml of 1.5% lidocaine with adrenaline and patients were sedated with intravenous midazolam 0.07mg kg(-1) and ketamine 0.5 mg kg(-1). A rescue dose of 0.15 mg kg(-1) of ketamine was given in group II if the patient complained of pain or discomfort during the procedure. Diclofenac sodium 1 mg kg(-1) was used for postoperative analgesia in both the groups. All patients were observed in the PACU until they met the discharge criteria. The demographic profile was similar in both the groups. The induction to skin incision time was significantly more in group I (5.13 ±0.93 min vs 3.01 ±1.86 min in group II). The decrease in pulse rate and blood pressure (systolic and diastolic) was also significant in group I. The incidence of intraoperative bradycardia was 16.7% and 10% in group I & group II respectively. The changes in SpO(2) during the procedure, recovery time and time to meet discharge criteria were comparable in both the groups. The incidence of PONV was 20% & 3.3% in group I and 10% & 6.6% in group II respectively. All patients in both the groups required postoperative analgesics. Both the techniques were found to be comparable for laparoscopic sterilization, however a longer induction to skin incision time and higher incidence of PONV and shivering in GA group makes LA with sedation a better choice.

Haemodynamic Responses to Insertion of Proseal Laryngeal Mask Airway with Sodium Thiopentone Preceded by Topical Lignocaine: A Comparison with Propofol alone

BACKGROUND: Propofol is the most common inducing agent for Laryngeal Mask Airway insertion but it causes haemodynamic instability.&#x0D; OBJECTIVE: To assess haemodynamic responses to insertion of Proseal Laryngeal Mask Airway (pLMA) with sodium thiopentone administration preceded by topical lignocaine and comparing with Propofol.&#x0D; METHODS: 100 patients of either sex in the age range of 16-60 years belonging to ASAI/II scheduled for open cholycystectomy were selected and allocated into one of the two groups. Group I (Propofol group) received Propofol 2.5mg/kg while as Group II (Thiopentone group) received topical lignocaine and intravenous sodium thiopentone for pLMA insertion. All patients received fentanyl 1μg/kg intravenously 3 minutes before induction. Haemodynamic parameters like pulse rate, mean systolic and diastolic blood pressures between the two groups were compared.&#x0D; RESULTS: The decrease in pulse rate, systolic and diastolic pressures in propofol group was more as compared to topical lignocaine and sodium thiopentone group while inserting pLMA. Number of attempts of pLMA insertion and oxygen saturation were same between the two groups when pLMA was inserted but the duration of apnoea was more in propofol than in topical lignocaine and sodium thiopentone group. Thus we concluded that sodium thiopentone administration preceded by topical lignocaine. (JMS 2010;13(2):56-59

Prevalence of immediate vasovagal reaction in blood donors visiting two blood banks of Karachi

Vasovagal reaction (VVR) is a very common adverse event related to blood donation. No study has been conducted in Pakistan to estimate the prevalence of VVR in blood donors. This study was conducted to estimate the prevalence of immediate VVR in blood donors of Karachi, Pakistan. The study was conducted in two blood banks of Karachi. Data regarding the development of immediate VVR were documented. The effect of blood donation on vital parameters like pulse rate, blood pressure (BP), temperature and respiratory rate was also observed. Six hundred and seventy-four blood donors were recruited. All the donors who consented were males. Weakness and dizziness were two most common symptoms which were reported by 91 (13.5%) and 73 (10.8%) of the participants, respectively. Out of 91 donors in whom signs and symptoms of immediate VVR were observed, a significant drop in systolic BP (13.5 +/- 2.5 mmHg) and decrease in pulse rate (13.3 +/- 3.6) were concurrently noted in 55 donors (8.2% of all the participants). There was lack of association of age, body mass index (BMI), estimated blood volume, ethnicity, educational status, profession and first time donation status with the frequency of VVR. Only marital status was found to be significantly associated with higher frequency of immediate VVR, where married donors were having higher odds as compared to singles. The prevalence of VVR in the blood donors at two blood banks of Karachi is at least 8.2%. Furthermore, married men are at more risk of experiencing VVR in our population.

Acute respiratory toxicity following inhalation exposure to soman in guinea pigs

Respiratory toxicity and lung injury following inhalation exposure to chemical warfare nerve agent soman was examined in guinea pigs without therapeutics to improve survival. A microinstillation inhalation exposure technique that aerosolizes the agent in the trachea was used to administer soman to anesthetized age and weight matched male guinea pigs. Animals were exposed to 280, 561, 841, and 1121 mg/m 3 concentrations of soman for 4 min. Survival data showed that all saline controls and animals exposed to 280 and 561 mg/m 3 soman survived, while animals exposed to 841, and 1121 mg/m 3 resulted in 38% and 13% survival, respectively. The microinstillation inhalation exposure LCt 50 for soman determined by probit analysis was 827.2 mg/m 3. A majority of the animals that died at 1121 mg/m 3 developed seizures and died within 15–30 min post-exposure. There was a dose-dependent decrease in pulse rate and blood oxygen saturation of animals exposed to soman at 5–6.5 min post-exposure. Body weight loss increased with the dose of soman exposure. Bronchoalveolar lavage (BAL) fluid and blood acetylcholinesterase and butyrylcholinesterase activity was inhibited dose-dependently in soman treated groups at 24 h. BAL cells showed a dose-dependent increase in cell death and total cell counts following soman exposure. Edema by wet/dry weight ratio of the accessory lung lobe and trachea was increased slightly in soman exposed animals. An increase in total bronchoalveolar lavage fluid protein was observed in soman exposed animals at all doses. Differential cell counts of BAL and blood showed an increase in total lymphocyte counts and percentage of neutrophils. These results indicate that microinstillation inhalation exposure to soman causes respiratory toxicity and acute lung injury in guinea pigs.

Efficacy and toxicity of homidium bromide (ethidium) in goats infected with T. vivax

The objectives of this study are to re-evaluate the efficacy and to investigate the toxicity of homidium bromide in goats experimentally infected with Trypanosoma vivax using different dosage regimens, standard parasitological, pathological, hematological and serobiochemical methods. Three infected groups were given single i.m. dosages of the drug at 1 mg/kg, 2.5 mg/kg and 5 mg/kg respectively. Another two infected groups were given repeated i.m. dosages of the drug at 1 mg/kg daily for 8 days or weekly for 3 successive weeks respectively. All drug rates used in this study eliminated the parasite from the peripheral blood and the liver except the single i.m. dose of 1 mg/kg. Single i.m. dose of homidium bromide at 5 mg/kg and 1 mg/kg repeated daily for 8 days was toxic and fatal preceded by severe clinical signs such as lacrimation, mucopurulent nasal discharge, frothy salivation, alopecia, colic, bloody diarrhea, increase in body temperature and respiratory rate, also decrease in pulse rate, body weight and blood pressure. These clinical signs accompanied by varying degrees of congestion and hemorrhages in the different body organs, hepatorenal fatty changes or necrosis, cardiomyositis, neuropathy, pneumonia and bloody enteritis and decrease in Hb, RBC, PCV as well as increase in AST and SDH activities. An increase was recorded in urea, total proteins and albumin concentrations. In conclusion, a single i.m. dosages of 2.5 mg/kg and 1 mg/kg weekly for 3 successive weeks were tolerated and successfully treated T. vivax infection.

Exercise Rehabilitation Restores Physiological Cardiovascular Responses to Short-term Head-Out Water Immersion in Patients With Chronic Heart Failure

Rehabilitation programs increasingly involve immersed exercising, including inpatients suffering from severe cardiovascular diseases such as coronary artery disease (CAD) or chronic heart failure (CHF). The hemodynamic responses to short-term head-out water immersion are not well defined in these diseases. This study was aimed at evaluating (1) the cardiac and peripheral hemodynamic responses to short-term head-out water immersion in patients with CHF (n = 12) and CAD (n = 12) and (2) the effect of a rehabilitation program on these responses. Wrist arterial tonometry was performed in the upright posture before and during immersion (1.30-m depth) once before and once after a 3-week rehabilitation program including gymnic water exercises. In patients with CAD, water immersion triggered a significant increase in stroke volume, cardiac output, and pulse pressure and a significant decrease in pulse rate, diastolic blood pressure, and systemic vascular resistances, both before and after the rehabilitation program. In patients with CHF, no significant immersion-linked changes in cardiovascular variables were observed before rehabilitation. However, after completion of the rehabilitation program, it was found that water immersion caused significant increases in stroke volume, cardiac output, and pulse pressure. In patients with CHF, this 3-week rehabilitation program restored the usual central responses to head-out water immersion (increase in stroke volume and cardiac output). In both patients with CHF and CAD, acute water immersion did not change arterial compliance.

SUNCT syndrome: The materialization of a headache syndrome.

Shortlasting, unilateral, neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome is a rare headache, described by our group in 1989. This overview presents our early studies of SUNCT pathogenesis. Due to the conspicuous ictal, ocular phenomena, ie, conjunctival injection and tearing, our studies started out with ocular parameters: intraocular pressure and corneal indentation pulse amplitudes, both of which showed clear ictal increments, symptomatic side. Beat-to-beat, noninvasive blood pressure measurements during attack showed instant, systolic blood pressure rise and corresponding pulse rate decrease. Carotid body, the principal peripheral chemoreceptor, seemed to function normally. The middle cerebral artery was dilated during attacks, particularly on the symptomatic side. Finally, some viewpoints are added regarding terminology. SUNCT is a workable and accepted term. There does not seem to be any need for another, fictitious term to describe the same clinical picture.

The Cardiovascular Effects of Thoracic Bolus Epidural Injection of Lidocaine, Morphine and Fentanyl during Sevoflurane General Anesthesia

Background: Sevoflurane is an inhalational anesthetic that produces rapid induction, emergence and little cardiovascular depression. Elevated sympathetic activity during surgery produces undesirable effects on the cardiovascular system, such as hypertension, tachycardia or arrhythmias. So combined general and epidural anesthesia have been used recently for the operation, especially the abdominal surgery. This study was performed to evaluate the cardiovascular effects of thoracic epidural anesthesia during sevoflurane general anesthesia. Methods: Forty patients of ASA class 1-2 undergoing elective subtotal gastrectomy were divided into 5 groups. Thoracic epidural bolus injection was administered via an epidural catheter during sevoflurane general anesthesia in a double-blind random manner: Group 1; normal saline (N/S) 10 ml (placebo), Group 2; morphine 0.1 mg/kg mixed with N/S in 10 ml, Group 3; fentanyl 1 mcg/kg mixed with N/S in 10 ml, Group 4; 1% lidocaine 10 ml, and Group 5; 1% lidocaine 10 ml mixed with morphine 0.1 mg/kg and fentanyl 1 mcg/kg. Systolic and diastolic blood pressures, pulse rates, peripheral oxygen saturation levels (Sp) and end-tidal carbon dioxide partial pressures (ETC) were measured every 5 minutes. Results: Systolic and diastolic blood pressures were significantly reduced from 10 minutes after epidural bolus injection in groups 4 and 5, but these decreases in blood pressure were not severe enough to require treatment in either group. Pulse rates were significantly decreased from 10 minutes after injection in groups 3, 4, and 5, but these decreases in pulse rate were not so severe enough to require treatment in 3 groups. Sp and ETC were stable, and arrhythmia was not observed. Conclusions: The thoracic epidural injection of 1% lidocaine mixed with morphine 0.1 mg/kg and fentanyl 1 mcg/kg can be safely used during sevoflurane anesthesia without severe cardiovascular complications during upper abdominal surgery in ASA 1-2 patients.

Efficacy of methylprednisolone pulse therapy in steroid-resistant nephrotic syndrome.

Steroid-resistant nephrotic syndrome (SRNS) in children is intractable, and the optimal treatment regimen is not known. We investigated the efficacy of methylprednisolone pulse therapy (MPT) in SRNS patients. Using only MPT plus heparin, we have treated ten pediatric SRNS patients that were resistant to cyclophosphamide (CPM) or cyclosporin A (CsA) and predicted to have a very poor prognosis. Administration of 30 mg/kg per day methylprednisolone with heparin for 3 days was taken as one course, and this was given 14 times over 2 years. One patient discontinued MPT because of peritonitis. Of the remaining nine patients, complete remission was achieved by four patients, persistent mild proteinuria remained in three patients, and no effect was observed in two patients. All patients that had been diagnosed with minimal change (MC) pathology ( n=3) at the initial renal biopsy achieved complete remission. Observed adverse events were peritonitis in one patient and a transient decrease in pulse rate only during MPT in one patient. These results demonstrate that MPT with heparin can induce remission in children with SRNS, even when the patient is resistant to CPM and CsA.

Continuous vs Intermittent β-Agonists in the Treatment of Acute Adult Asthma: A Systematic Review With Meta-analysis

Since the late 1980s, there has been considerable clinical and academic interest in the use of continuous aerosolized bronchodilators for the treatment of patients with acute asthma. These studies have suggested that this therapy is safe, is at least as effective as intermittent nebulization, and may be superior to intermittent nebulization in patients with the most severely impaired pulmonary function. To determine whether continuous nebulization offered an advantage over intermittent nebulization for the treatment of adults with acute asthma in the emergency department (ED). Systematic review of randomized controlled trials of adults with acute asthma. Change in pulmonary function tests as primary outcome, and admissions to the hospital and side effects as secondary outcomes. Six studies including 393 adults with acute asthma were selected. No significant differences were demonstrated between the two delivery methods in terms of pulmonary function measures obtained after 1 h of treatment (standardized mean difference [SMD], -0.15; 95% confidence interval [CI], -0.35 to 0.05) and after 2 to 3 h of treatment (SMD, -0.19; 95% CI, -0.39 to 0.01). No significant heterogeneity was demonstrated (p > 0.5). At the end of treatment, there was a significantly greater decrease in pulse rate when the continuous nebulizer was used (weighted mean difference [WMD], -6.82; 95% CI, -8.67 to -3.90 beats/min; chi(2), 2.55; degrees of freedom [df], 4; p = 0.6). Additionally, the analysis showed a significant decrease of serum potassium concentration with the use of intermittent nebulization (WMD, 0.12; 95% CI, 0.24 to 0.01 mmol/L; chi(2), 0.5; df, 2; p = 0.8). However, this finding was obtained on the analysis of only two trials. Finally, at the end of the study period, no significant differences were identified between patients treated with continuous or intermittent nebulization with respect to hospital admission (relative risk, 0.68; 95% CI, 0.33 to 1.38; chi(2), 2.06; df, 1; p = 0.2). Overall, this review supports the equivalence of continuous and intermittent albuterol nebulization in the treatment of acute adult asthma.

Diagnosis of early Takayasu arteritis with sonography.

Takayasu arteritis is a large-vessel vasculitis that occurs predominantly in young females. The diagnosis is not usually established before arterial stenoses or occlusions are present. The aim of the study was to find out if sonography can aid in the diagnosis of the disease in earlier stages. We describe three patients with early disease who had no haemodynamically relevant stenoses. They are compared with nine patients who were diagnosed in the stenotic/occlusive stage of the disease. All patients were German Caucasian females. Colour Doppler sonography and angiography were performed in all cases. Patients with early disease had general symptoms of fatigue and arthralgia and laboratory signs of inflammation, but neither bruits nor decrease of pulse rate. Sonography of the carotid and subclavian arteries demonstrated a characteristic, homogeneous, midechoic, circumferential thickening of the wall. At this stage of the disease it was difficult to get unequivocal results with angiography. In all nine remaining patients, sonography also demonstrated inflammation of the subclavian or carotid arteries, as did angiography in eight of these patients. Sonography of the carotid and subclavian arteries aids in the detection of early Takayasu arteritis. In young females with unclear symptoms and laboratory findings of generalized inflammation, the primary extracranial branches of the aortic arch should be investigated by sonography to detect early Takayasu arteritis.

Social phobic interoception: effects of bodily information on anxiety, beliefs and self-processing

It has been suggested that body-state information influences self-perception and negative thinking in social phobia [Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In R. G. Heimberg, M. R. Liebowitz, D. A. Hope & F. R. Schneier (Eds.), Social phobia: diagnosis, assessment and treatment (pp. 69–93). New York: Guilford Press.]. This study explored the effects of body-state information on anxiety and cognition in patients with generalised social phobia during a feared social interaction. It was hypothesised that information concerning an increase in pulse rate would lead to increments in anxiety, negative beliefs and self-processing whilst information concerning a decrease in pulse rate would have the opposite effect. The results of this study were generally consistent with the hypotheses. These findings are important as they may help to account for fluctuations in anxiety, negative beliefs and self-processing in social situations that do not present objective social threat. In particular, social anxiety appears to be modulated by body-state information. The implications of the present findings for cognitive therapy of social phobia are briefly discussed.

Changes of Pulse Rate and Skin Temperature Evoked by Electroacupuncture Stimulation with Different Frequency on both Zusanli Acupoints in Humans

The purpose of this study was to investigate the effect of electroacupuncture stimulation (EA) of different frequency on pulse rate and skin temperature. Sixteen healthy male medical student volunteers received EA of 2 Hz, and 100 Hz, respectively on the both Zusanli acupoints (St-36) while resting. Their pulse rates were measured on the middle finger, and skin temperature was taken between the thumb and index finger before, during, and after EA stimulation. Each test took 35 minutes. The initial 10 min were defined as baseline period (no EA), the following 15 min as the EA period and the last 10 min as the post-EA period. Three assessments were performed on each subject as follows: A) control assessment: no EA was done throughout the test; B) 2 Hz EA assessment: 2 Hz EA was applied to both Zusanli acupoints during the EA period; and C) 100 Hz EA assessment: 100 Hz EA was applied to both Zusanli acupoints during the EA period. Our results indicate that both 2 Hz EA and 100 Hz EA decreased pulse rates during the EA period, and these changes remained throughout the post-EA period in 2 Hz EA assessment, but not in 100 Hz EA assessment. Both 2 Hz and 100 Hz EA resulted in decreases of skin temperature during the EA period. Our conclusions are that 2 Hz EA and 100 Hz EA applied to both Zusanli acupoints resulted in the decrease of pulse rate, which possibly evoked greater parasympathetic nerve activity on heart beats. 2 Hz EA had a more sustained effect on heart beats than 100 Hz EA. Decreased skin temperatures in the EA period may have resulted from cutaneous vasoconstriction caused by EA induced sympathetic stress response, suggesting EA at least remains for 15 min in clinical application.

Alpha sympathomimetic treatment of autonomic insufficiency with orthostatic hypotension

In this double-blind study, the authors compared the safety and efficacy of the investigational oral agent midodrine, a specific alpha 1-sympathomimetic agent, with ephedrine, a nonspecific alpha- and beta-adrenergic receptor agonist. Eight patients (4 men and 4 women) with refractory orthostatic hypotension resulting from autonomic failure were studied. This study was based on the notion that neurogenic orthostatic hypotension results from attenuation of adrenergic nerve traffic and not from alpha-adrenergic receptor dysfunction. Although arteriolar vasoconstrictors seem to be appropriate therapeutic agents, their success has been limited, and the search for an ideal drug is ongoing. The authors employed a blocked, double-blind, randomized crossover design. The single-blind placebo run-in period was 2 days. The double-blind titration period with either midodrine or ephedrine was 3 to 5 days; the titration end point was to increase standing systolic blood pressure to > or = 80 mm Hg and to maintain a supine pressure below 180/100 mm Hg. The maintenance period was 3 to 5 days. A 4-day placebo washout period was interposed at the crossover point. The ability to stand improved in patients treated with midodrine but not with ephedrine. Midodrine significantly increased both systolic (P < 0.001) and diastolic (P < 0.001) standing blood pressure over placebo (P < 0.001) and ephedrine (P < 0.05). In contrast, ephedrine-induced changes in standing pressures did not significantly differ from placebo (P > 0.05). Midodrine treatment improved the frequency of the ability to stand as compared with ephedrine, and was associated with a significantly higher incidence of standing systolic pressures > 80 mm Hg than was placebo (P < 0.001). Both midodrine and ephedrine significantly increased supine systolic and diastolic blood pressures over placebo (P < 0.001, P < 0.01, P < 0.01, P < 0.01, respectively), but were not significantly different from each other. Ephedrine significantly increased (P < 0.05) the pulse rate as compared with placebo and midodrine, whereas midodrine produced a statistically significant (P < 0.05) but clinically minimal decrease in pulse rate compared with placebo. Neither drug affected clinical laboratory variables. Midodrine safely and effectively improved orthostatic hypotension caused by autonomic failure. Our data suggest that the ability to stand is improved better by midodrine than by ephedrine.