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At least 631 records · Page 35Linked to original sources
PubMed1995

Hemodynamic and autonomic reflex effects of chronic N-type Ca2+ channel blockade with omega-conotoxin GVIA in conscious normotensive and hypertensive rabbits.

The effects of chronic administration of omega-conotoxin GVIA (omega-CTX), an N-type Ca2+ channel blocker, on hemodynamics and autonomic reflexes were studied in conscious normotensive (sham) and hypertensive (wrap) New Zealand white rabbits. During surgery, a pulsed Doppler-flow probe was implanted around the lower abdominal aorta, and both kidneys were wrapped in cellophane (wrap) or left undisturbed (sham). Rabbits were studied 4 weeks later on 5 consecutive days. On days 1-4, hemodynamics, the baroreceptor-heart-rate (HR) reflex induced by drugs and the Bezold-Jarisch-like reflex evoked by serotonin, were measured before and 2 h after administration of omega-CTX (10 micrograms/kg i.v. bolus). On day 5, hemodynamics and reflexes were again assessed, but no further omega-CTX was given. On day 1, omega-CTX caused falls in mean arterial pressure (MAP) of 17 +/- 3 and 27 +/- 5 mm Hg in sham (n = 6) and wrap (n = 11) rabbits, respectively, with tachycardia. Hindquarter vascular conductance (HVC) increased > 35% in both groups. On days 2-4, omega-CTX still caused falls in MAP; however it was progressively less than on day 1. HR and HVC did not change. After omega-CTX on day 1, there was marked attenuation of the sympathetic components and decrease in the vagal components of the baroreceptor-HR reflex curves, with HR range decreasing by > 61% in sham and wrap rabbits. These curves remained similar over the next 4 days, and were unaffected by further omega-CTX. However, omega-CTX had no effect on the vagally mediated Bezold-Jarisch-like reflex. In auxiliary experiments in vitro, omega-CTX (1 nM) inhibited sympathetic, but not vagal, responses to electrical nerve stimulation of rabbit-isolated right atria. Thus, omega-CTX is a potent hypotensive agent in normotensive and hypertensive rabbits, predominantly via a peripheral sympatholytic action with no effect on vagal-cardiac efferent activity. However, it may affect the vagal component of the baroreceptor-HR reflex by an unknown central mechanism.

Animals↗
PubMed2003

Vasomotor instability in neonates with chromosome 22q11 deletion syndrome.

Approximately 70% of individuals with chromosome 22q11 deletion syndrome (22q11DS) have congenital heart defects. A host of other vascular problems in these patients, such as tortuous carotid arteries, Raynaud's phenomenon, unexplained hypotension, hypertension, and hypothermia, raise the possibility that there may be abnormal autonomic regulation of the vascular system. So far, however, there has been no formal report of autonomic dysfunction in patients with 22q11 deletion. We present two infants with 22q11DS, who had profound hypotension after uncomplicated surgeries for congenital heart disease. The hypotension was not responsive to vasopressor treatment (and extracorporeal membrane oxygenation in one infant) and resulted in death, due to multiorgan system failure. Obvious causes, such as poor cardiac contractility, prolonged circulatory arrest, neurological abnormality, sepsis and blood loss were excluded. On autopsy, no abnormalities were found that could explain the hypotension. We hypothesize that these infants died of severe hypotension due to abnormal vascular tone and that this is a variable feature in individuals with 22q11 deletion. The autonomic nervous system, which is responsible for the regulation of vasomotor tone, may be variably affected in 22q11DS. This could have implications for the surgical management of patients with 22q11DS. Further studies on this topic would establish or refute the association between 22q11DS and dysautonomia.

Adult↗
PubMed2002

Narrative discourse in young children with histories of early corrective heart surgery.

Narrative attainment was assessed in a group of 76 four-year-old children at risk for brain injury because of histories of early corrective heart surgery. Elicited personal experience narratives were coded for narrative components, evaluative devices, and information adequacy and were contrasted with narratives produced by a comparison group of typically developing 4-year-olds. The production of autonomous narrative discourse was identified as an area of special vulnerability for children with this medical history. Despite considerable heterogeneity in narrative performance, children with early corrective heart surgery produced fewer narrative components than typically developing children. Results suggest that the elaboration of events and contextual information, the expression of subjective evaluation and causality, and clarity and explicitness of information reporting may constitute special challenges for this population of children. Implications of these findings for clinical assessment and possible risks for socioemotional relationships and academic achievement are discussed.

Achievement↗
PubMed1984

[The thyrotropic function of the hypophysis and peripheral thyroid hormones after removal of bland and autonomous nodular goiters].

Bilateral subtotal resection or enucleation or unilateral resection was performed in 60 patients (36 with bland nodular goitre, 24 with autonomic adenoma). The thyrotropic pituitary activity and the peripheral thyroid function were examined in all patients preoperatively and followed up for 12 months postoperatively. The results show that all patients with bilaterally resected bland nodular goitre require postoperative administration of thyroid hormone, since enhanced thyrotropic activity is seen not later than three months after surgery. Since thyrotropic function remains normal in unilaterally operated nodular goitre, thyroid hormone administration does not appear generally necessary. In patients with autonomic adenoma there is postoperatively variability of function, independent of the surgical method employed. In view of possible functional recompensation, final decision on the administration of thyroid hormones should not be made before the end of the sixth postoperative month. These results can be considered as guidelines for a differentiated postoperative management.

Goiter, Nodular↗
PubMed2001

[Influential factors in mortality rate from congenital heart disease. Study of 1,216 children in the Autonomous Community of Murcia (1978-1990)].

INTRODUCTION: In the last few years, important progress has taken place in management of congenital heart disease. These changes have had an influence on diagnosis, preoperative management, surgery treatment and postoperative care, giving rise to better results in the treatment of children suffering from congenital heart disease. AIM: To assess the results of congenital heart diseases in a reference hospital by comparing two periods with reference to both diagnosis and therapeutical management. We also intend to investigate the influence that factors such as the existence of extracardiac congenital malformations and heart surgery have on mortality. PATIENTS AND METHODS: Our sample group was made up of 1,216 children suffering from congenital heart disease. Their ages ranged from 1 day to 7 years old. These children were born over a period of thirteen years and studied at the paediatric cardiology unit in a reference hospital in the Autonomous Community of Murcia, a region of Spain. We retrospectively analysed their development by individual heart diseases (and their associated factors), and the global results. Our research was divided into two periods: between 1978 and 1983, and between 1984 and 1990. Differences were found regarding diagnosis and treatment. RESULTS: a) Mortality rate from congenital heart disease decreased in the period between 1984 and 1990 in comparison to the period between 1978 and 1983, from 28 to 21,7% (p < 0.05); b) individually, the mortality rate decreased with statistical significance in two diseases: interventricular communication and patent ductus arteriosus, and c) there is a higher mortality rate of patients with no surgery treatment and/or extracardiac malformations. CONCLUSION: Progress in the management of congenital heart disease has led to a more favourable outcome in the last years.

Child↗
PubMed2001

Autonomic nervous system and gut-derived endotoxin: involvement in activation of Kupffer cells after in situ organ manipulation.

Gentle in situ organ manipulation rapidly causes disturbances in the hepatic microcirculation, hypoxia, and activation of Kupffer cells. Because the mechanisms of Kupffer cell activation after organ manipulation remain unclear, the possible role of the autonomic nervous system and gut-derived endotoxin were assessed. To mimic what occurs with major abdominal surgery, livers from female Sprague-Dawley rats (200-230 g) underwent minimal dissection for 12 minutes and were manipulated gently or were left alone for 13 subsequent minutes. Kupffer cells were activated 2 hours after manipulation, reflected by a significant increase in intracellular calcium ([Ca2+]i) from about 90 nM in unmanipulated controls to more than 180 nM in response to lipopolysaccharide (LPS 100 ng/ml). Furthermore, Kupffer cells from manipulated rats produced about threefold more tumor necrosis factor-alpha after LPS (100 ng/ml) than did the unmanipulated controls. Moreover, O2 uptake of ex situ perfused liver was increased from about 110 micromol/g/hr in unmanipulated controls to more than 160 micromol/g/hr 2 hours after organ manipulation. Binding of pimonidazole (120 mg/kg IV), a 2-nitroimidazole hypoxia marker given 2 hours after manipulation, increased about 2.5-fold, and hepatic glycogen was depleted. Two hours after organ manipulation gut permeability to horseradish peroxidase was elevated and endotoxin in the portal venous blood was increased twofold. Microsurgical hepatic denervation, ganglionic blockade, adrenalectomy, and antibiotics to sterilize the gut before manipulation prevented activation of Kupffer cells by organ manipulation. Hexamethonium and adrenalectomy prevented increases in gut permeability caused by manipulation. Although antibiotics blunted the increase in portal venous endotoxin significantly, there was no effect on gut permeability. These data indicate for the first time that both the autonomic nervous system and gut-derived endotoxin are involved in activation of Kupffer cells after organ manipulation.

Adrenalectomy↗
PubMed1985

Adult aqueduct stenosis and diencephalic epilepsy. A case report.

A white male developed severe headaches at the age of 31 years. Aqueduct stenosis with hydrocephalus was diagnosed. Some months after surgery (shunt) his behaviour altered and eventually he became mute and akinetic. Frequent episodes of marked autonomic over-activity occurred. The clinical and necropsy findings of aqueduct stenosis, hydrocephalus and periaqueductal gliosis, led us to believe that these indicated diencephalic epilepsy.

Adult↗
PubMed1994

Bilateral gustatory sweating as a sign of diabetic neuropathy.

Gustatory sweating is a relatively common sequela to parotidectomy and is almost always unilateral in nature. This article presents a case of bilateral gustatory sweating in a patient with no history of facial trauma or surgery who was undergoing periodontal therapy. A thorough examination determined the cause of diaphoresis to be autonomic neuropathy as a result of a 26-year history of Type II diabetes mellitus. Few cases of this rare complication of diabetes have been described, and the current case represents the first report in the dental literature.

Aged↗
PubMed2003

Neurourological changes before and after radical hysterectomy in patients with cervical cancer.

BACKGROUND: The severity of bladder dysfunction in patients receiving radical hysterectomy for cervical cancer has been related to the delicacy and the degree of radicality of the hysterectomy. Our goal was to evaluate the effect of modified radical hysterectomy on the storage and evacuation of the lower urinary tract. METHODS: In this prospective study, 18 patients underwent radical hysterectomy for cervical cancer with FIGO stages Ia, Ib and IIa. These patients participated in a pudendal motor nerve conduction study and a urodynamic study, including urethral pressure profile (UPP), cystometry (CMG) and uroflowmetry (UFR). These were carried out at preoperative baseline and at 2 weeks, 6 weeks, 3 months and 6 months following surgery. We used generalized linear models to evaluate, over time, the relationship between the different parameters marked in these profiles. RESULTS: The average pudendal nerve motor latency was prolonged at 2 and 6 weeks after surgery but recovered to baseline at 3 months postsurgery. Maximal urethral closing pressure revealed a tendency to decrease, and the CMG showed a significant increase in maximum intravesical filling pressure and a marked decrease in compliance throughout the investigative course. Increased residual urine volume and decreased uroflow rates were detected in a series of UFR. However, these values headed for baseline at 6 months after surgery. CONCLUSION: Transient neurological changes in the majority of our patients suggested that both somatic and autonomic demyelination with or without denervation might be responsible for the temporal changes in vesicourethral function after radical hysterectomy and recovery to baseline condition within 6 months.

Adult↗