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At least 955 records · Page 53Linked to original sources
PubMed2000

Autoantibodies to ganglionic acetylcholine receptors in autoimmune autonomic neuropathies.

BACKGROUND: Idiopathic autonomic neuropathy is a severe, subacute disorder with a presumed autoimmune basis. It is indistinguishable from the subacute autonomic neuropathy that may accompany lung cancer or other tumors. Autoantibodies specific for nicotinic acetylcholine receptors in the autonomic ganglia are potentially pathogenic and may serve as serologic markers of various forms of autoimmune autonomic neuropathy. METHODS: We tested serum from 157 patients with a variety of types of dysautonomia. Immunoprecipitation assays with iodine-125-labeled epibatidine and solubilized human neuroblastoma acetylcholine receptors were used to detect autoantibodies that bound to or blocked ganglionic receptors. RESULTS: Ganglionic-receptor-binding antibodies were found in 19 of 46 patients with idiopathic or paraneoplastic autonomic neuropathy (41 percent), in 6 of 67 patients with postural tachycardia syndrome, idiopathic gastrointestinal dysmotility, or diabetic autonomic neuropathy (9 percent), and in none of 44 patients with other autonomic disorders. High levels of the binding antibodies correlated with more severe autonomic dysfunction (including the presence of tonic pupils). Levels of these antibodies decreased in patients who had clinical improvement. All seven patients with ganglionic-receptor-blocking antibodies had ganglionic-receptor-binding antibodies and had idiopathic or paraneoplastic autonomic neuropathy. CONCLUSIONS: Seropositivity for antibodies that bind to or block ganglionic acetylcholine receptors identifies patients with various forms of autoimmune autonomic neuropathy and distinguishes these disorders from other types of dysautonomia. The positive correlation between high levels of ganglionic-receptor antibodies and the severity of autonomic dysfunction suggests that the antibodies have a pathogenic role in these types of neuropathy.

Adult↗
PubMed1991

Single potential analysis of cavernous electrical activity in impotent patients: a possible diagnostic method for autonomic cavernous dysfunction and cavernous smooth muscle degeneration.

Cavernous electrical activity was recorded in 214 patients with erectile dysfunction and in 39 normal patients. In 34 of the 39 normal patients potentials of a uniform shape were recorded during flaccidity. At cutoff frequencies of 0.5 to 500 Hz. the duration was 8 to 18 seconds (mean 12.8 +/- 2.8, seconds, standard deviation), the amplitude was 250 to 750 microv. (mean 444 +/- 109 microv.) and the polyphasity was 8 to 22 (mean 13.8 +/- 3.3). With increasing tumescence and rigidity during audiovisual sexual stimulation, high frequency potentials of low amplitude and short duration were found in the normal patients. In impotent patients with an upper motor neuron or peripheral lesion specific types of potentials were observed. In 11 of 14 impotent patients with insulin-dependent diabetes for more than 20 years and with clinical findings of cavernous myopathy the potentials showed low amplitude, irregular shape and slow depolarizations. Abnormal findings of cavernous electrical activity were recorded in 51.6% of the consecutive impotent patients. Our clinical study suggests that single potential analysis of cavernous electrical activity may be useful in the diagnosis of cavernous autonomic neuropathy and cavernous smooth muscle myopathy.

Adult↗
PubMed1999

Autonomic function in patients with hereditary motor and sensory neuropathy type I and Lambert-Eaton myasthenic syndrome.

Noninvasive tests of four autonomic organ systems (vasomotor control, baroreceptor reflexes, sudomotor function and pupillary reflexes) were performed on nine patients with hereditary motor and sensory neuropathy (HMSN) type I and three patients with Lambert-Eaton myasthenic syndrome (LEMS). The results were compared with those of 33 control subjects. Autonomic dysfunction was considered present when at least two of the four organ system tests were abnormal. The three patients with LEMS had abnormal results in two or more different systems, whereas only one of the nine patients with HMSN type I had two abnormal test results. This study demonstrates that autonomic dysfunction is not a common finding in patients with HMSN type I and its presence should alert us to find the cause of this autonomic disorder.

Adolescent↗
PubMed2006

Influence of autonomic nervous dysfunction characterizing effect of diabetes mellitus on heart rate response and exercise capacity in patients undergoing cardiac rehabilitation for acute myocardial infarction.

BACKGROUND: The aim of this study was to clarify the influence of sympathetic and parasympathetic nerve (SN and PN) dysfunction on the heart rate (HR) response to exercise and the exercise capacity of patients with acute myocardial infarction (AMI) and diabetes mellitus (DM). METHODS AND RESULTS: Fifty-two male patients who underwent cardiopulmonary exercise testing (CPX) 1 month after onset of AMI were divided into 2 groups: (DM (+) group, n=20; DM (-) group, n=32). HR, peak oxygen uptake (VO2peak), and plasma norepinephrine (NE) levels were measured during CPX. The high-frequency power (HF) was analyzed by HR variability. The DeltaHR/logDeltaNE obtained from changes of HR and NE from rest to peak exercise and HR change from baseline to the minimum HF (DeltaHRHF) were calculated as parameters of HR response derived from SN and PN activities, respectively. DeltaHR, VO2peak, DeltaHR/logDeltaNE, and DeltaHRHF were significantly lower in the DM (+) group than in the DM (-) group, and both of them showed positive correlations with VO2peak. CONCLUSION: An inadequate HR response to exercise is a major factor causing a decline of exercise capacity, which is derived from both of SN and PN dysfunction, in AMI patients with DM.

Autonomic Nervous System↗
PubMed1999

A study of changes in the status of autonomic nervous system in primary open angle glaucoma cases.

Control of Intra Ocular Pressure (IOP) is influenced by both divisions (sympathetic and para-sympathetic) of Autonomic Nervous System (ANS). The present study was conducted to confirm existence of any association of ANS with primary open angle glaucoma (POAG), if present. Systemic autonomic function tests were assessed in fifty patients of POAG with fifty normal subjects matched for sex and age as control using several well established tests based on cardiovascular reflex responses to standardised stimuli viz. Resting heart rate (RHR), Corrected QT Interval (QTc), T-wave amplitude, Standing to Lying Ratio (SLR); Valsalva Ratio; Galvanic Skin Resistance (GSR) and Cold Pressor Test (CPR). Tests were conducted in the Department of Physiology, Maulana Azad Medical College and associated Glaucoma Clinic of Guru Nanak Eye Centre from june '94-May '95. Subjects were randomly chosen from known POAG cases with IOP--25 +/- 5.08 mm Hg. The results showed decrease in both sympathetic and para-sympathetic activity of autonomic function tests in POAG suggesting associated autonomic dysfunction. Sympathetic under-activity is seen in 36 patients out of 50 (73%), POAG subjects while para-sympathetic activity is decreased in 43 of 50 (86%) of the POAG subjects when compared with normal control group. The results help concluding that POAG is associated with autonomic dysfunction with decreased activity of both sympathetic and para-sympathetic divisions of ANS.

Autonomic Nervous System Diseases↗
PubMed2003

Pulmonary function, cholinergic bronchomotor tone, and cardiac autonomic abnormalities in type 2 diabetic patients.

This prospective study analyzed the involvement of the autonomic nervous system in pulmonary and cardiac function by evaluating cardiovascular reflex and its correlation with pulmonary function abnormalities of type 2 diabetic patients. Diabetic patients (N = 17) and healthy subjects (N = 17) were evaluated by 1) pulmonary function tests including spirometry, He-dilution method, N2 washout test, and specific airway conductance (SGaw) determined by plethysmography before and after aerosol administration of atropine sulfate, and 2) autonomic cardiovascular activity by the passive tilting test and the magnitude of respiratory sinus arrhythmia (RSA). Basal heart rate was higher in the diabetic group (87.8 +/- 11.2 bpm; mean +/- SD) than in the control group (72.9 +/- 7.8 bpm, P<0.05). The increase of heart rate at 5 s of tilting was 11.8 +/- 6.5 bpm in diabetic patients and 17.6 +/- 6.2 bpm in the control group (P<0.05). Systemic arterial pressure and RSA analysis did not reveal significant differences between groups. Diabetes intragroup analysis revealed two behaviors: 10 patients with close to normal findings and 7 with significant abnormalities in terms of RSA, with the latter subgroup presenting one or more abnormalities in other tests and clear evidence of cardiovascular autonomic dysfunction. End-expiratory flows were significantly lower in diabetic patients than in the control group (P<0.05). Pulmonary function tests before and after atropine administration demonstrated comparable responses by both groups. Type 2 diabetic patients have cardiac autonomic dysfunction that is not associated with bronchomotor tone alterations, probably reflecting a less severe impairment than that of type 1 diabetes mellitus. Yet, a reduction of end-expiratory flow was detected.

Adult↗
PubMed1999

Uremic autonomic neuropathy studied by spectral analysis of heart rate.

BACKGROUND: There is good evidence that power spectral analysis (PSA) of heart rate variability may provide an insight into the understanding of autonomic disorders. METHODS: We investigated 30 chronic uremic patients who were on periodic bicarbonate hemodialysis by a battery of six cardiovascular autonomic tests (beat-to-beat variations during quiet breathing and deep breathing, heart rate responses to the Valsalva maneuver and standing, blood pressure responses to standing and sustained handgrip) and PSA of heart rate variations. RESULTS: Eleven patients (37%) had an abnormal response to only one parasympathetic test. Twelve patients (40%) had a definite parasympathetic damage, as indicated by at least two abnormal heart rate tests, whereas four (13%) had combined parasympathetic and sympathetic damage. Multivariate analysis of the cardiovascular tests revealed that 19 patients (63%) had moderate-to-severe autonomic neuropathy (AN), and 11 patients exhibited normal autonomic function. Among the symptoms suggestive of autonomic dysfunction, only impotence in males was significantly associated with test-proven AN. The PSA of the heart rate variability demonstrated a good discrimination of low-frequency (LF) and high-frequency (HF) bands (LF, 0.03 to 0.15 Hz; HF, 0.15 to 0.33 Hz) among controls, uremic patients without test-proven AN, and uremic patients with test-proven AN. A significant reduction of the LF value on supine uremic patients without AN suggests that an early sympathetic involvement exists that traditional autonomic tests were unable to detect. CONCLUSIONS: Our study indicates that the current opinion of a major parasympathetic damage in chronic uremic patients on hemodialysis has to be modified in favor of a more widespread autonomic dysfunction involving both the sympathetic and parasympathetic pathways.

Adult↗
PubMedDate not supplied

Dysautonomia in dogs: a retrospective study.

Dysautonomia was diagnosed in 11 young (median age, 14-months), predominantly medium- to large-breed dogs from 1988 to 1995. Clinical signs caused by autonomic dysfunction of the urinary, alimentary, and ocular systems were most common. Dysuria, mydriasis, absence of pupillary light reflexes, decreased tear production, dry mucous membranes, weight loss, and decreased anal tone were present in over 75% of affected dogs. Ocular pharmacological testing with a dilute (0.1%) solution of pilocarpine was used to demonstrate iris sphincter receptor function in all dogs. A low-dose (0.0375 mg/kg s.c.) bethanechol test and pharmacological testing with phenylephrine and epinephrine also demonstrated cholinergic and adrenergic receptor function in 4 dogs. All dogs died or were euthanized as a results of autonomic dysfunction. Neuronal depletion, with associated gliosis and minimal inflammation were noted histologically in the autonomic ganglia of each dog. The pelvic, ciliary, celiac, cranial cervical, and cranial and caudal mesenteric ganglia were affected in all dogs. The cause of autonomic failure in these dogs was not determined.

Animals↗
PubMed1988

The role of vasopressin in blood pressure maintenance in diabetic orthostatic hypotension.

The purpose of these studies was to assess the role of vasopressin in maintaining supine and upright blood pressures in hypertensive diabetic subjects. Patients with (n = 6) or without (n = 10) evidence of autonomic insufficiency had blood pressure and heart rate monitored before and after receiving an intravenous injection of 0.5 mg of a V1 vasopressin inhibitor. None of the patients had supine changes in blood pressure or heart rate. However, upon assuming the erect position, the six patients with preexisting orthostatic hypotension had an average blood pressure fall of 44 mm Hg after vasopressin inhibition (as opposed to 20 mm Hg before), accompanied by a modest rise in heart rate of 20 beats/min. Those without autonomic dysfunction were separated into two subgroups. Four developed an average fall in orthostatic blood pressure of 18 mm Hg after vasopressin inhibition, whereas the remaining six had no change. There were no distinguishing hormonal characteristics (vasopressin, renin, and catecholamine levels) between the groups, but in the patients with autonomic dysfunction, the renin level failed to rise when upright. We conclude that vasopressin plays an important role in preventing or minimizing orthostatic hypotension in diabetic patients. Its pressor contribution is crucial in those with autonomic insufficiency and impaired renin and sympathetic responses, in whom the pressor effectiveness of vasopressin is greatly enhanced.

Arginine Vasopressin↗
PubMedDate not supplied

[Character of central hemodynamics in hypotensive type autonomic vascular dysfunction in juveniles].

With an aid of an ultrasound investigation of the heart, aspects of central hemodynamics in 408 juveniles ranging in age between 11 to 14 years have been studied. Of these, 339 were diagnosed as having hypotensive type vegetovascular dysfunction, the other 69 essentially healthy juveniles formed a control group signs of systolic and diastolic dysfunction of the myocardium of the left ventricle revealed in the patients with hypotensive type vegetovascular dysfunction. Systolic dysfunction was compensated by increase in the rate of the heart's beat. Compensation of diastolic dysfunction was achieved by increase in contractility of the muscle of the left ventricle.

Adolescent↗
PubMedDate not supplied

Pancreatic polypeptide is increased in patients with advanced malignant disease.

BACKGROUND: Augmented secretion of pancreatic polypeptide (PP) has been demonstrated in patients with severe systemic diseases or endocrine tumors. The aim of this study was to evaluate PP and autonomic neuropathy in patients with advanced malignant disease. MATERIALS AND METHODS: Basal PP assessments and five cardiovascular tests for autonomic function were used. Twenty patients, including 11 patients with lung cancer (69 yrs +/- 11, mean +/- SD) and 10 healthy age-matched controls, were studied. RESULTS: PP levels were significantly higher in the patients than in the controls (pmol/L 107.0 +/- 111.4 versus 28.2 +/- 13.4, p<0.05). In the parasympathetical tests, the patients showed significantly decreased heart rate response to the Valsalva manoeuvre (ratio 1.20 +/- 0.19 versus 1.46 +/- 0.23, p<0.005). Also, in the sympathetical tests, the blood pressure response to standing up was significantly decreased (mmHg -3.84 +/- 17.53 versus 10.80 +/- 8.89, p<0.05). The heart rate response to standing up and deep breathing as well as the blood pressure response to sustained handgrip, did not differ significantly between the groups. In spite of the apparent autonomic dysfunction among cancer patients with advanced malignant disease, PP levels were significantly higher in these patients when compared with healthy controls. CONCLUSION: PP levels were significantly higher in patients with advanced cancer than controls, regardless of autonomic dysfunction in the cancer patients. This finding supports the hypothesis that PP may, in some cancer patients, be a marker of advanced malignant disease.

Adult↗
PubMed2006

Urinary dysfunction and autonomic control in amyloid neuropathy.

Uro-neurological assessment was performed in four patients with small-fiber neuropathy due to amyloidosis (2 transthyretin-type/2 immunoglobulin light-chain-type). Voiding difficulties were due to detrusor weakness and impaired bladder sensation. In two patients cholinesterase inhibition treatment caused urge incontinence, indicating detrusor denervation supersensitivity. The underlying mechanisms of urinary dysfunction seem to involve postganglionic cholinergic and afferent somatic nerves.

Aged↗
PubMed1987

Mitral valve prolapse: from syndrome to disease.

Mitral valve prolapse (MVP) is due to a heterogeneous group of conditions that may affect the mitral valve or the mitral valve apparatus. Although MVP may progress later in life to frank mitral insufficiency requiring mitral valve repair or may predispose to bacterial endocarditis, in most cases it is a benign, idiopathic condition without serious consequences. However, many investigators have documented that MVP is often associated with a constellation of signs and symptoms, which appear to constitute a distinct syndrome. These associated findings include autonomic dysfunction, frequent complaints of chest pain, palpitations, orthostasis, fatigue, dyspnea on exertion and anxiety. Although the risk of significant myocardial dysfunction or bacterial endocarditis appears to be related to patient sex, age and the severity of valvular prolapse and insufficiency, there appears to be little or no relations between the extent of prolapse and the degree of autonomic dysfunction or the severity of symptoms of chest pain, palpitations, dyspnea on exertion and anxiety. The development of uniform diagnostic standards for mental disorders has helped to make it possible to identify several related entities, including generalized anxiety disorder, panic disorder and agoraphobia; patients with these disorders frequently somatize their anxiety and complain of many symptoms which may be seen in patients with MVP. Although several studies have reported an increased frequency of MVP in patients with anxiety disorders, recent studies suggest that the conditions are not linked. Iatrogenic cardiac neurosis is common in both groups of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Anxiety↗
PubMed2004

Hypertrophic osteoarthropathy may be a marker of underlying sympathetic bias.

Hypertrophic osteoarthropathy (HOA) is a condition that accompanies many seemingly unrelated diseases. It is commonly associated with various clinical conditions such as pregnancy, aging, pulmonary diseases, cancers, and other systemic illnesses. The condition has been attributed to various causes such as platelet abnormalities, hormonal disturbances, and cytokine dysfunction, but the exact underlying mechanism has been elusive. We propose a unifying hypothesis that activation of the adrenergic system is the common thread that links all of the disparate clinical associations of hypertrophic osteoarthropathy. In diseased states, autonomic stimulation may occur as a result of chemoreceptor activation in response to acidosis, hypoxia, or hypercapnia. Examples include sleep apnea, congestive heart failure, renal failure, and tumor-induced hypoxia. In this setting, clinical signs of HOA may be a marker of underlying autonomic dysfunction. Autonomic stimulation may also occur as a normal part of pregnancy or as an abnormal component of aging. The exact pathway linking adrenergic excess to HOA remains to be clarified, but a plausible scenario based on current molecular evidence is offered.

Adrenergic Agents↗
PubMedDate not supplied

Two patients with distal muscular dystrophy and autonomic nerve dysfunction.

Two female patients with distal muscular dystrophy (Miyoshi) are reported. Neurological examination revealed marked weakness and a low skin temperature of both lower legs, especially over the gastrocnemius muscle. Biopsy specimens of the anterior tibial muscle exhibited myopathological features compatible with a dystrophic change and showed positive dystrophin reactions with all six antibodies used. Autonomic nerve studies in both patients, including laser Doppler flowmetry (LDF), component analysis of the cardiographic R-R interval and a sympathetic skin response (SSR) test, demonstrated marked abnormalities, such as sensitive vasoconstrictive responses, a suppressed peak of low frequency components and an absence of SSR, respectively, compared with findings in healthy controls. Sympathetic nerve blocking by means of epidural anesthesia produced clinical improvement and a marked decrease in the serum CK level in one patient. Although the etiology of autonomic nerve disturbances in these cases remains to be elucidated, a positive immunoreactivity of nerve growth factor receptor (NGFR) implies the possibility of some unknown sympathetic neurovascular disorder involving muscle degeneration.

Adolescent↗
PubMed1988

Unusual manifestations of basilar artery ectasia.

Three patients with unusual presentations of basilar artery ectasia are described: subarachnoid hemorrhage was manifest in one and autonomic dysfunction developed in the other two. Aneurysmal rupture was the cause in the first patient, while compression of the brainstem and/or of the baroreceptor afferences of the IXth and Xth cranial nerves is postulated to be responsible for the symptoms found in the other two. Basilar artery aneurysms should be considered in cases with subarachnoid hemorrhage or autonomic dysfunction, particularly when diagnostic procedures fail to disclose other possible etiologies.

Autonomic Nervous System Diseases↗
PubMed1988

Cardiomyopathy of Duchenne muscular dystrophy.

A total of 18 male patients with Duchenne muscular dystrophy (DMD), aged 8-29 years (mean, 15.7 years), were prospectively studied to assess the cardiomyopathy associated with DMD, using clinical parameters and noninvasive cardiovascular investigations: electrocardiogram (ECG), Holter monitoring, and echocardiography. In addition, five clinical tests of cardiovascular autonomic function were used to assess the role of the autonomic nervous system in the pathogenesis of dysrhythmias. The majority of subjects were asymptomatic, but four had abnormal physical findings. All had abnormal ECG, the commonest abnormality (in 16) being tall R waves or increased R/S ratios in the right precordial leads; 14 had abnormal findings on echocardiography, including three with poor left ventricular function and five with mitral valve prolapse (MVP). Labile abrupt sinus tachycardia was present in 11, and four had high-grade ventricular ectopy. None had definite clinical evidence of autonomic dysfunction. The cardiomyopathy of DMD appears to be unrelated to disease severity. However, abnormal Q waves or Q/R ratios in ECG leads I, aVL9 and V5-V6 are significantly related to young age (p less than 0.05), and high-grade ventricular ectopy occurred significantly more frequently (p less than 0.05) in older subjects (greater than 15 years). Dysrhythmias were not related to the presence of MVP, poor left ventricular function, or autonomic dysfunction.

Adolescent↗