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Influence of long-term aldose reductase inhibitor therapy on autonomic dysfunction of urinary bladder, stomach and cardiovascular systems in diabetic patients.

The effects of the aldose reductase inhibitor (ARI) sorbinil (250 mg/day) were tested in an open-label pilot study over 1 year, in eight diabetics with peripheral neuropathy, seven of whom had symptomic autonomic neuropathy (AN). Autonomic function studies of the urinary bladder, stomach and cardiovascular system were performed at baseline, 6 and 12 months. Six patients reported improvement in symptoms of AN by 6 months which was maintained or further improved by 12 months. Bladder sensation, as measured by cystometrographic parameters, improved at 6 months (P less than 0.02- less than 0.04), but by 12 months had reverted to baseline. Residual urine volume decreased at 6 months (P less than 0.06) and 12 months (P less than 0.06). Vagally mediated gastric acid secretion improved at 6 months (P less than 0.06); the subgroup of patients with subnormal secretion showed improvement to the normal range at 6 months (P less than 0.03). Gastric emptying of solid food was normal in six of eight subjects and showed no significant change at 6 months. Both patients with delayed emptying normalized. No change in beat-to-beat variability in heart rate with respiration was noted. Resting minimum heart rate decreased at 12 months (P less than 0.05). Glycohemoglobin levels showed no statistically significant changes. No toxic reactions were observed. These data suggest a beneficial effect of ARI treatment on symptomatic and asymptomatic manifestations of diabetic autonomic neuropathy and indicate a need for large controlled trials.

Adult↗

[Comparative characteristic of blood filling and vascular tone in arterial vessels of patients with arterial hypertension and somatic form of autonomic dysfunction after Chernobyl accident (according to rheoencephalography and rheovasography data)].

Clear-cut distinction in blood vascular filling and vascular tone of arterial vessels of the cerebral hemisphere and shanks in patients suffered from Chernobyl accident and with arterial hypertension and vegetative dysfunction manifested somatically has been detected by means of impedance tetrapolar plethysmography (rheoanalyzer RA5-01).

Adult↗

Sleep apnoea syndrome: states of sleep and autonomic dysfunction.

Eleven patients with upper airway apnoea during sleep (one with SHY-Drager syndrome) were monitored polygraphically for wakefulness, sleep, and cardiovascular variables. Systemic hypertension and most of the severe arrhythmias recorded during sleep were secondary to repetitive obstructive apnonea and were mediated through the autonomic nervous system. Sleep related elevations of pulmonary arterial pressure were not influenced by atropine or impaired autonomic functions. Upper airway sleep apnoea is sleep related; the type of sleep (REM or NREM) is critical in the appearance of abnormalities. The distinction between two patient subgroups (total sleep dependent and NREM sleep dependent) has haemodynamic, and possibly long-term, implications. Sleep apnoea syndrome should be looked for in pateints with the Shy-Drager syndrome.

Adult↗

[Effects of different methods of physical therapy on the course of autonomic dysfunction syndrome].

A comparative randomized controlled trial was made of efficacy of vegetative disorders correction with drugs and physiotherapeutic factors. A total of 120 patients with vegetative vascular dystonia entered this trial. Its results demonstrated that addition of physiotherapy to the rehabilitation complex allows differential functional changes in the autonomic nervous system. This can be used for optimization of rehabilitation programs.

Adult↗

Autonomic dysfunction in diphtheritic neuropathy.

Sympathetic and parasympathetic function and somatic nerve conduction were assessed in ten patients with diphtheritic neuropathy and 28 controls. None of the patients had postural hypotension. The Valsalva ratio was abnormal in two patients who also had myocarditis, but it was normal in five cases. Cardiac vagal dysfunction was found in five patients. One case showed cardiac parasympathetic denervation despite normal conduction velocity in the limbs.

Adolescent↗

Evidence for cardiovascular autonomic dysfunction in neonates with coarctation of the aorta.

BACKGROUND: Coarctation of the aorta (CoA) is associated with hypertension and abnormalities of blood pressure control, which persist after late repair. Assumptions that neonatal repair would prevent development of blood pressure abnormalities have not been supported by recent data. We hypothesized that early pathological adjustment of autonomic cardiovascular function may already be established in the neonate with coarctation. METHODS AND RESULTS: We studied 8 otherwise well neonates with simple CoA and compared measures of spontaneous baroreflex sensitivity, heart rate variability, and blood pressure variability with 13 healthy newborn babies. Spontaneous baroreflex sensitivity was calculated with sequence methodology from an ECG, and noninvasive blood pressure was recorded with a Portapres. Heart rate variability was determined with time- and frequency-domain measures. Blood pressure variability was measured in the frequency domain. In comparison with normal controls, neonates with CoA had raised blood pressure (78.9+/-3.8 versus 67.1+/-2.1 mm Hg), depressed baroreflex sensitivity (8.7+/-1.5 versus 13.8+/-1.1 ms/mm Hg), reduced heart rate variability (total power 16.5+/-3.1 versus 31.5+/-2.2 ms2), and an increase in the high-frequency component of blood pressure variability (3.1+/-0.3 versus 2.2+/-0. 2 mm Hg2). This is not the pattern expected if neonates with CoA simply had subclinical cardiac failure. CONCLUSIONS: These data suggest that infants with CoA already show signs of pathological adjustment of autonomic cardiovascular homeostasis. Further longitudinal studies are required to determine whether these alterations play a role in the increased risk of late hypertension in these patients.

Aortic Coarctation↗

Abnormalities of the corrected QT interval in familial dysautonomia: an indicator of autonomic dysfunction.

We report abnormalities in corrected QT intervals with changes in position and after exercise in patients with familial dysautonomia and confirm the previously reported finding of abnormal heart rate and blood pressure responses. Prolonged corrected QT intervals (> 440 msec) with lack of appropriate shortening with exercise is a noninvasive means of demonstrating an aberration in autonomic regulation of cardiac conduction.

Adult↗

Acetate and bicarbonate hemodialysis in patients with and without autonomic dysfunction.

To test the contribution of bicarbonate (Bi) to hemodynamic stability during hemodialysis (HD), we compared the effects of ultrafiltration dialysis with bicarbonate and with acetate under conditions of high-sodium (141 mEq/liter) and low-sodium (130 mEq/liter) dialysate concentrations in 12 stable HD patients. Group 1 was patients (N = 5) who had normal findings on autonomic testing; group 2, patients (N = 7) who had abnormal findings on autonomic testing. All patients and staff were unaware of which dialysis was being used. During the high-sodium dialysate studies, changes in mean blood pressure (MBP), cardiac output (CO), and orthostatic tolerance to standing after HD were similar in both groups of patients with both acetate and bicarbonate dialysate. When the studies were repeated under low-sodium dialysate conditions, several differences emerged between acetate and bicarbonate HD. In group 1, the frequency of adverse symptoms upon standing after HD were reduced with bicarbonate (P less than 0.05). In group 2, bicarbonate HD prevented a significant decrease in orthostatic MBP after HD. These results suggest that bicarbonate affords no greater hemodynamic stability than does acetate if a dialysate sodium of 141 mEq/liter is used. With lower sodium dialysate, bicarbonate appears to provide a modest improvement in decreasing orthostatic symptoms and signs in patients with and without autonomic insufficiency.

Acetates↗

Reproducibility of cardiovascular autonomic tests in diabetics with and without autonomic dysfunction and in normal controls.

The present study evaluates the reproducibility of five cardiovascular reflex tests, deep breathing (DB), Valsalva maneuver (VM), sustained hand-grip (SHG), postural hypotension (PH) and lying to standing (LS) in normal subjects and in insulin dependent (type I) diabetic patients. The study was carried out in 10 normal subjects, in 10 diabetics with autonomic neuropathy and in 10 diabetics without autonomic neuropathy. The five cardiovascular reflex tests were performed five times on five consecutive days by the same investigator and in identical basal conditions. The intraindividual variability of DB, LS and VM was significantly reduced in diabetics with autonomic neuropathy compared with normal controls, but there was no difference between diabetics without neuropathy and normal controls. The intraindividual variability of PH was significantly increased in diabetics with autonomic neuropathy compared with diabetics without autonomic neuropathy and with normal controls. There was no difference among the three groups in the reproducibility of SHG. In normal subjects the intraindividual variability only exceptionally produced a shift from normal to abnormal values or vice versa; in diabetics with autonomic neuropathy this shift was more frequent.

Adult↗

[Autonomic dysfunction in Guillain-Barré Syndrome: a 13 year experience in pediatric intensive care unit].

The acute inflammatory demyelinating polyneuropathy (Guillain-Barré Syndrome) might have a severe presentation but a good prognosis in children. It is an immune-mediated and inflammatory disorder of the peripheral nervous system. This retrospective study observed that GBS is frequently complicated by hypertension and other autonomic disorders. Cardiovascular instability is due to the involvement of the autonomic nervous system and results in labile blood pressure, cardiac dysrhythmias and hypovolemia. During a 13-year period (1982-1995), 21 children were admitted to the Pediatric Intensive Care Unit of São Lucas Hospital, Porto Alegre, south of Brazil. Eight patients were mechanically ventilated. Symptoms of autonomic disturbance were frequently seen, especially in patients with severe clinical evolution. Previous investigations of the mechanism of hypertension associated with GBS did not evaluate the etiology of these phenomena. With modern pediatric intensive care support the deaths are rare. There is no death in this studied group.

English Abstract↗