Nervous Dysfunction In Patients Research Articles

Ultrasound of the Vagus Nerve as an indicator of autonomic nervous dysfunction in patients with diabetic neuropathy

Ultrasound of the Vagus Nerve as an indicator of autonomic nervous dysfunction in patients with diabetic neuropathy

Predictors and diagnosis of cardiac autonomic nervous dysfunction in patients with type 1 and type 2 diabetes mellitus

Diabetic cardiovascular autonomic neuropathy (DCAN) is a diabetic complication characterised by early dissemination of sympathetic and parasympathetic, small-fibre neuronal degeneration. DCAN is the most dangerous and insidious complication that influences the clinical course and mortality rate of diabetes; however, it is often underestimated and not recognised by practitioners. Medical history and a physical examination are not sufficient for diagnosing DCAN. Laboratory diagnosis and the instrumental methods used to evaluate DCAN are time-consuming and not always available. Early detection of DCAN in diabetic patients is important for the early implementation of therapy. Today, there is no uniform diagnostic algorithm for DCAN in patients with various disorders of carbohydrate metabolism. This is due to the insufficient number of clinical trials and limitations of current protocols.
 This review presents an overview of the clinical and experimental studies of DCAN. The epidemiology, clinical manifestations, risk factors and underlying pathogenesis of DCAN are considered. The advantages and disadvantages of conventional and new diagnostic methods are discussed.

59. Can sacral SSR recordings be useful in the assessment of autonomic nervous dysfunction in patients with sacral-pudendal impairment?

While it is well know the usefulness of neurophysiological tests to investigate somatic nervous system of pelvic floor, it is not yet recognized the real efficacy of sympathetic skin response (SSR). In the last years we examined more than 1500 patients with different pelvic disorders (age range 7–85 years). All patients were studied with pudendal EMG, SEP, MEP, sacral reflexes. SSR was recorded from skin of sacral area (i.e. penis or mons pubis, perineal area, perianal area according to symptoms), applying random single square pulses at wrist or supraorbital region. SSR latency and amplitude were measured and the results were compared by mean age with those of control group. We observed alterations in latency and/or amplitude and in some cases SSR changes were the only present abnormality. We have also observed that it is important to differentiate anterior from posterior perineal area in SSR recording. SSR test may be a useful tool to investigate autonomic sacral involvement, because until now it is the only test to explore autonomic system. In our experience SSR is always present, in absence of pathology, so it could become a standard investigation for clinical routine of patients with sacral disorders.

P442: The value of SSR recordings in the assessment of autonomic nervous dysfunction in patients with sacral-pudendal impairment

P442: The value of SSR recordings in the assessment of autonomic nervous dysfunction in patients with sacral-pudendal impairment

876 “VOIDING DYSFUNCTION PHENOTYPING OF WOMEN WITH CHRONIC PELVIC PAIN SYNDROMES: RESULTS FROM THE ICEPAC TRIAL”

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Interstitial Cystitis1 Apr 2013876 “VOIDING DYSFUNCTION PHENOTYPING OF WOMEN WITH CHRONIC PELVIC PAIN SYNDROMES: RESULTS FROM THE ICEPAC TRIAL” Elias Veizi, Adonis Hijaz, Firouz Daneshgari, and Thomas Chelimsky Elias VeiziElias Veizi Cleveland, OH More articles by this author , Adonis HijazAdonis Hijaz Cleveland, OH More articles by this author , Firouz DaneshgariFirouz Daneshgari Cleveland, OH More articles by this author , and Thomas ChelimskyThomas Chelimsky Milwaukee, WI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.445AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Interstitial cystitis/Bladder pain syndrome (IC/BPS) and myofascial pelvic pain (MPP) are two of the most common forms of chronic pelvic pain (CPP). Cross organ sensitization in pelvis complicates the clinical diagnosis and treatment of IC/PBS as part of general CPP. ICEPAC trial aims to study the autonomic nervous dysfunction in patients with interstitial cystitis and myofascial pain and aims to assess the signature phenotypes of pain and voiding dynamic changes. METHODS ICEPAC supported by NIH-NIDDK was designed by an interdisciplinary team. Enrollment will include 76 women with IC, 76 women with myofascial pelvic pain disorder (MPP), 38 1st degree female relatives of IC subjects without pelvic pain, and 38 healthy age-matched women. Besides a detailed screening visit with comprehensive assessment of dysautonomias, pain intensity and disability scores, voiding dysfunction phenotype is assessed by Uroflow and a voiding diary. VAS scores, frequency, voiding volumes, flow parameters and timed flow assessment data are collected and analyzed. RESULTS This preliminary analysis includes the first 60 patients [29 healthy control (con) subjects; 23 IC/BPS patient and 8 chronic MPP]. Subjects enrolled in the study are age matched [con 40±15, IC 39.6±15, MPP 40.5±14 yo]. BMI in MPP patients is significantly higher than Hcon and IC subjects [42±5 vs 26±9 in con and 27±8 in IC]. Voiding volumes were lower in the IC group vs H con and MPP whether frequency was higher in the IC group with similar fluid intake. The peak flow [Qmax] was significantly lower in the IC cluster 16±2 ml/sec vs. 28±11 con, 23±4 MPP; while the average flow rate was lower in both IC and MPP vs. con. Similarly duration of flow was higher in IC and MPP vs. con. CONCLUSIONS This preliminary quantitative evaluation of voiding diary and uroflow metrics reveals distinct voiding phenotypes in IC and MPP. The decrease in Qmax in IC cluster in comparison to con and MPP could be an indication of the internal sphincter autonomic dysfunction while the prolonged voiding duration and avg flow in MPP patients could indicate external sphincter hypertonicity [incomplete relaxation]. Further details on voiding dysfunction could lead toward a better understanding of the pathogenesis in IC vs other pelvic floor dysfunction syndromes. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e361-e362 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elias Veizi Cleveland, OH More articles by this author Adonis Hijaz Cleveland, OH More articles by this author Firouz Daneshgari Cleveland, OH More articles by this author Thomas Chelimsky Milwaukee, WI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Autonomic Nervous System Dysfunction in Lifelong Premature Ejaculation: Analysis of Heart Rate Variability

To identify autonomic nervous dysfunction in patients with lifelong premature ejaculation. The study participants were 25 men with lifelong premature ejaculation and 25 healthy controls. The parameters of 24-hour heart rate variability that are influenced by the autonomic nervous system were compared between the men with lifelong premature ejaculation and the healthy controls. The laboratory results of all patients were within normal limits, and no significant differences were found between the patients and the controls in age, body weight, and body mass index. A low-frequency signal that is influenced by the sympathetic system was increased in the patients (P = .026). Furthermore, a high-frequency signal that is influenced by the parasympathetic system was decreased in the patients (P = .011). Finally, the low frequency-to-high frequency ratio, an indicator of the balance between the two components of the autonomic nervous system, was increased in the patients (P = .002). To our knowledge, no study has investigated the influence of the autonomic nervous system on 24-hour heart rate variability in premature ejaculation. In the present study, sympathetic activity was increased in men with lifelong premature ejaculation; this overactivity might lead to lifelong premature ejaculation. Additional studies are required to reveal the possible alteration of the autonomic nervous system in premature ejaculation.

Hypoxemia and autonomic nervous dysfunction in patients with chronic obstructive pulmonary disease

Hypoxemia is known to be associated with abnormal heart rate variability (HRV) that can reflect the severity of the illness and may have prognostic value in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to examine the relationship between the derangements in cardiac autonomic nervous function and the oxygenation status or degree of airflow obstruction in COPD patients by using HRV analysis. Thirty clinically stable COPD patients and 18 age-matched normal subjects were included in this study. The normalized high-frequency power (nHFP) and the low-/high-frequency power ratio (LFP/HFP) were used as indices of vagal activity and sympathovagal balance, respectively. Although global HRV measures were all significantly decreased, the nHFP and LFP/HFP of COPD patients were not significantly different from those of normal controls. There was a negative correlation between nHFP and arterial partial pressure of O2 (PaO2) and a positive correlation between LFP/HFP and PaO2 in COPD patients. No correlation existed between forced expiratory volume in 1.0 s/forced vital capacity (FEV1/FVC), % predicted of FEV1 (%FEV1) and nHFP or LFP/HFP in COPD patients. The resting autonomic nervous function of COPD patients is not different from that of normal controls. Though the degree of airway narrowing is not related to the cardiac autonomic nervous function, chronic hypoxemia can lead to enhanced cardiac vagal activity and depressed sympathetic activity in COPD patients. A worse oxygenation status is associated with increased cardiac vagal and decreased cardiac sympathetic activities in COPD patients.

The effect of kidney transplantation on autonomic nervous dysfunction in patients with chronic renal failure

AUTONOMIC nervous dysfunction (AND) is wellrecognized complication of chronic renal failure (CRF). Abnormalities of vagal function with possible combined sympathetic disturbances have been reported most commonly. Few reports dealing with the effects of kidney transplantation on AND found in the literature make this subject rather contradictory. Some of the authors found some improvement or even almost complete normalization of AND after kidney transplantation in non–diabetic neuropathy, although others found no improvement of autonomic indices in nondiabetic neuropathy in patients with end-stage renal disease (ESRD). The aim of our study was to investigate the degree and the course of AND in patients with ESRD after successful kidney transplantation.

Saliva in non-insulin-dependent diabetic patients and control subjects: The role of the autonomic nervous system

Objective. The purpose of this investigation was to study the flow rate and organic constituents of whole saliva in relation to autonomic nervous function in patients with non-insulin-dependent diabetes. Study design. We studied the associations of saliva factors and autonomic nervous function in 45 patients with non-insulin-dependent diabetes (mean age, 68 ± 6 years) and 77 control subjects (mean age, 67 ± 5 years). The metabolic evolution was well known over a 10-year period from the time of diagnosis. Resting and paraffin-wax-stimulated whole saliva samples were collected and analyzed. Autonomic nervous function was evaluated by measuring heart rate variation during deep breathing and change in systolic blood pressure during orthostatic testing and by means of power spectral analysis of heart rate variability while standing. The effect of drugs used on saliva was also studied. Results. No difference was seen in flow rate between the patients with diabetes and the control subjects; resting flow rates were 0.3 ± 0.3 ml/min in the patients with diabetes and 0.3 ± 0.2 ml/min in the control subjects, and stimulated flow rates were 1.2 ± 1.4 ml/min in the patients with diabetes and 1.2 ± 0.8 ml/min in the control subjects. The number of drugs used daily correlated with salivary flow rates of the control subjects ( p < 0.001) but not with flow rates of the patients with diabetes. The effect of xerogenic medication on salivary flow rates was stronger in patients with diabetes than in control subjects, however. There were no statistically significant differences between patients with diabetes and control subjects in the organic constituents of saliva. The stimulated saliva secretion was associated with total power ( r s = 0.343; p = 0.035), medium-frequency power ( r s = 0.375; p = 0.020), and high-frequency power ( r s = 0.414; p = 0.010) of heart rate variability in patients with diabetes. Conclusion. Saliva secretion might be more affected by xerogenic drugs and autonomic nervous dysfunction in patients with non-insulin-dependent diabetes than in nondiabetic control subjects.

Characterization and natural course of cardiac autonomic nervous dysfunction in HIV-infected patients.

To examine the degree, pattern, and natural history of cardiac autonomic nervous dysfunction in patients infected with HIV. Cross-sectional and prospective longitudinal cohort study. Primary care and tertiary referral university centre. Thirty-five consecutive HIV-infected patients who had either not yet developed AIDS (15 pre-AIDS patients) or who were at the Centers for Disease Control and Prevention (CDC) AIDS stage (n = 20), and 29 healthy age- and sex-matched HIV-negative controls. Computer-aided power spectral analysis of 15 standardized parameters of heart-rate variability (HRV). Pre-AIDS patients as a group did not exhibit any HRV parameters to be significantly different from healthy controls (P > 0.017), whereas AIDS patients demonstrated reduced HRV in 14 parameters (93.3%) compared with healthy subjects (p > 0.017). Median proportion of abnormal HRV parameters (< 10th percentile of controls) per individual was 9.1% in pre-AIDS patients and 61.3% in AIDS patients (P = 0.0347). Progressive CDC stages inversely correlated to 10 HRV parameters (66.7%; -0.50 < or = r < or = -0.36; P < 0.05). Follow-up testing in 10 pre-AIDS and six AIDS patients after 6-16 months (median, 12.5 months) did not reveal deterioration of HRV (P < 0.05). A dysautonomia symptom score correlated to 10 HRV parameters (66.7%; -0.14 < r < -0.55; P < 0.05). Cardiac autonomic nervous dysfunction is severe in AIDS patients, although not significant in pre-AIDS patients. Cardiac autonomic nervous dysfunction proceeds with HIV disease progression, although its individual course is slow.

Autonomic nervous dysfunction in patients with implanted defibrillator

Autonomic nervous dysfunction in patients with implanted defibrillator

Assessment of QT interval prolongation and autonomic nervous dysfunction in patients undergoing orthotopic liver transplantation

The acu-men;™: A new device for continuous renal replacement therapy in acute renal failure.We sought to design a simple machine to safely provide continuous veno-venous hemofiltration to acute renal failure patients.The acu-men™ device uses a pneumatic blood pump with tidal blood flow as the driving force. A volumetric balancing system balances the filtrate with the replacement fluid, and the blood—air interface is eliminated by replacing the conventional venous drip chamber with two air-separating membranes. The extracorporeal circuit is integrated in a disposable cartridge, which is inserted into the machine at the beginning of treatment. The priming and rinsing is done automatically.While preliminary data from an ongoing clinical trial on the efficacy of this device are encouraging, further longer-term studies are necessary to evaluate its potential to decrease morbidity and mortality in acute renal failure patients.

めまい患者の自律神経機能 脈波伝播速度による検討

Patients subject to vertigo have been said to have autonomic nervous dysfunction, especially sympathetic hyperresponsiveness or parasympathetic hyporesponsiveness. Sympathetic nervous function in vertigo patients, in relation to antonomic nervous dysfunction, was examined by means of pulse wave velocity (PWV). In this study, 47 patients (12 with autonomic nervous dysfunction 12 with Meniere's disease, 8 with vertebrobasilar insufficiency and 15 others) were examined. R-R interval measurements on ECG were performed simultaneously to evaluate parasympathetic function. Autonomic nervous dysfunction, was confirmed in 24 patients. PWV, especially, reflects sympathetic nerve function, 13 patients (54.2 %) showed hyperresponse and 10 (41.7%) hyporesponse. In contrast, 18 (75 %) showed normal parasympathetic function. These results suggest that autonomic nervous dysfunction in patients with vertigo is mainly sympathetic dysfunction and that the measurement of PWV may be a useful diagnostic modality.

Autonomic nervous dysfunction in patients on long-term hemodialysis.

The level of plasma dopamine-beta-hydroxylase (DBH) activity in subjects at rest was found to be significantly lower in 12 patients on long-term hemodialysis than in a healthy 8-member control group: 28.3 +/- 7.2 and 13.6 +/- 7.6 IU/1, respectively (p less than 0.01). Following immersion of one hand of each subject into cold water (4 degrees C) for 1 min, a significant rise was observed in both groups, 6.1 +/- 4.8 IU/1 for the control and 1.6 +/- 1.4 IU/1 for the patient group (p less than 0.01). Upon tilting up the head of all subjects, activity in both groups increased significantly, but a markedly smaller rise was found in the patient group: 5.8 +/- 4.8 and 1.1 +/- 1.6 IU/1 for the two groups, respectively (p less than 0.01). The data suggest an autonomic nervous dysfunction in patients on long-term hemodialysis.