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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Clinical autonomic research 1 (1991), S. 3-3 
    ISSN: 1619-1560
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1619-1560
    Keywords: Chronic renal failure ; Autonomic nervous system ; Parasympathetic ; Heart rate ; Heart rate variability
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Heart rate variability was measured from 24-h electrocardiograms in 61 patients with end stage chronic renal failure. The method used counts the number of times successive RR intervals differ by more than 50 ms over the 24-h period, and is a reliable indicator of cardiac parasympathetic activity. Also analysed were the frequency and type of ectopic beats and other arrhythmias. Twentyone subjects (34%) had varying numbers of ventricular ectopic beats, and twelve (20%) had frequent supraventricular ectopics. Total 24-h count values were abnormal in 30 (76%) of the 41 subjects whose tapes were technically suitable for this analysis. There were no sex differences, but those patients maintained on haemodialysis had significantly lower counts than those on continuous ambulatory peritoneal dialysis. We conclude that about three-quarters of patients with chronic renal failure have abnormal cardiac parasympathetic activity. This may increase susceptibility to cardiac arrhythmias and sudden death and contribute to the high mortality of patients with chronic renal failure.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1619-1560
    Keywords: Autonomic nervous function ; Cardiovascular reflex tests ; Obstructive sleep apnoeas ; Sleep apnoea syndrome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Ten patients with obstructive sleep apnoea syndrome cured by uvulopalatopharyngoplasty were compared to nine patients considered as surgical failures, using cardiovascular reflex tests—Valsalva manoeuvre, respiratory sinus arrhythmia, isometric handgrip and head-up tilt. Two patients had signs of moderate vagal dysfunction, but no case of definite autonomic nervous dysfunction was diagnosed. The overall results indicated sympathetic overreactivity, positively correlated to oxygen desaturation indices and remaining after successful treatment. Four patients did not exhibit bradycardia during sleep apnoea. Two of them had decreased respiratory sinus arrhythmia when awake, but two had normal values. This implies a difference in vagal responsiveness between the awake and sleeping states, or that other factors besides vagus function influence the bradycardia response to apnoea. The group mean values were all within normal limits. There was no significant difference between the two groups in any test. Autonomic nervous dysfunction therefore does not seem to contribute to surgical failure, nor to occur with increased incidence among patients with primary obstructive sleep apnoea syndrome.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1619-1560
    Keywords: Parkinsonism ; Multiple system atrophy ; Cerebellar degeneration ; Autonomic failure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We reviewed the clinical and autonomic features of all patients with extrapyramidal and cerebellar disorders studied in the Mayo Autonomic Reflex Laboratory from 1983 to 1989. Patients were grouped into the following categories (number in parentheses): Parkinson's disease (35); parkinsonism-plus (54); multiple system atrophy (75); hereditary multisystem degenerations (eleven); progressive supranuclear palsy (32); non-familial cerebellar degeneration (eleven); nonspecific sporadic multisystem degeneration (73). Severe autonomic failure occurred in 97% of patients with multiple system atrophy and 53% of the nonspecific sporadic multisystem degeneration patients respectively. Autonomic involvement was mild or absent in Parkinson's disease while parkinsonism-plus and non-familial cerebellar degeneration patients had moderate autonomic failure. Orthostatic blood pressure reduction, percentage of anhidrosis on thermoregulatory sweat test, quantitative sudomotor axon reflex test, forearm response and heart rate response to deep breathing strongly regressed with severity. A response to levodopa treatment in patients with parkinsonism was more likely if cerebellar signs and cognitive deficits were absent. The presence of levodopa induced dyskinesia was also a marker for a clinically favourable levodopa response. We conclude that there is a spectrum of autonomic involvement in these degenerative disorders and that autonomic studies are useful in separating them and monitoring their course.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Clinical autonomic research 1 (1991), S. 177-178 
    ISSN: 1619-1560
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1619-1560
    Keywords: Plasma catecholamines ; Dihydroxyphenylglycol ; Neuronal uptake ; Sympathetic nervous system ; Noradrenaline kinetics ; Idiopathic orthostatic hypotension
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Primary autonomic failure is a heterogenous group of diseases with evidence for lesions in both the central and peripheral elements of the autonomic nervous system. We determined the extent of peripheral sympathetic dysfunction in six patients with primary autonomic failure without clinical evidence of central nervous system involvement (pure autonomic failure) using biochemical methods for studying regional noradrenaline spillover and removal. The results were compared with those from 14 agematched normal subjects, seven of whom were studied before and after pharmacological neuronal uptakeblockade with desipramine. Total, cardiac and renal noradrenaline spillover to plasma were 78%, 98% and 66% lower respectively in pure autonomic failure than in normal subjects (p 〈 0.001). Total noradrenaline plasma clearance was 20% lower in pure autonomic failure (p 〈 0.005) than in normal subjects and similar to the level observed in normal subjects following neuronal noradrenaline uptake-blockade with desipramine, mean transcardiac extraction of tritiated noradrenaline was 74% in normal subjects and 20% in pure autonomic failure, identical to the value post-desipramine in normal subjects. Cardiac spillover of the noradrenaline precursor, dihydroxyphenylalanine, and the primary intra-neuronal metabolite dihydroxyphenylglycol, were 78% and 94% lower respectively in pure autonomic failure than in normal subjects (p 〈 0.001). These data indicate a marked reduction in the apparent release rate and neuronal uptake of noradrenaline in the hearts of patients with pure autonomic failure, and provide biochemical evidence of almost total postganglionic sympathetic denervation in this condition.
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  • 7
    ISSN: 1619-1560
    Keywords: Clonidine ; Captopril ; Renal artery stenosis ; Hypertension ; Sympathetic ; Central neurogenic mechanisms
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The contribution of neurogenic mechanisms in maintaining hypertension was investigated in 13 patients with unilateral renal artery stenosis (twelve with normal, one with grossly elevated plasma renin levels) by determining the haemodynamic and hormonal responses to the centrally acting sympatholytic agent, clonidine. The same patients were studied after captopril to determine the dependency of their blood pressure on the direct peripheral effects of angiotensin-II. Sixteen patients with essential hypertension (normal plasma renin) were additionally studied after clonidine. After clonidine, blood pressure fell markedly in patients with renal artery stenosis (17 ± 3%) and essential hypertension (18 ± 2%). In both groups, clonidine lowered cardiac output by a reduction in stroke volume and heart rate; forearm vascular resistance was unchanged but digital skin vascular resistance fell. Plasma noradrenaline levels were normal in both groups and fell after clonidine; plasma renin activity and aldosterone levels were unchanged. After captopril, blood pressure fell minimally (5 ± 3%) in renal artery stenosis patients; cardiac output fell and forearm and digital skin vascular resistance were unchanged. Plasma renin activity rose, plasma aldosterone fell and plasma noradrenaline was unchanged after captopril. In the patient with grossly elevated renin levels, blood pressure fell minimally (6%) after clonidine, but unlike others fell profoundly (37%) after captopril. We conclude that, in the majority of our renal artery stenosis patients, despite the elevated blood pressure, sympathetic nervous activity was not reduced. Central neurogenic mechanisms appear to play an important role in maintaining raised blood pressure. In the same patients the peripheral effects of angiotensin-II did not maintain vascular tone or hypertension. The ischaemic kidney has a key role however, as revascularization or nephrectomy cured or ameliorated the hypertension.
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  • 8
    ISSN: 1619-1560
    Keywords: Autonomic neuropathy ; Diabetes mellitus ; Postural hypotension ; Xamoterol ; Beta1 partial agonist
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Recent reports have suggested that xamoterol, a beta1 adrenoceptor partial agonist with 43% intrinsic sympathomimetic activity improves symptomatic postural hypotension in patients with primary autonomic failure. To evaluate the use of xamoterol in eleven insulin dependent patients with diabetes mellitus who had postural hypotension (over 20 mmHg systolic blood pressure) secondary to autonomic neuropathy, we performed a double-blind, randomized, placebo controlled crossover study with xamoterol (200 mg bd orally) for 1 month. Treatment with xamoterol raised supine systolic blood pressure by 11 mmHg but a reduced standing systolic blood pressure by 11 mmHg with an increase in the standing-supine systolic blood pressure difference. No significant differences were observed in symptom score, HbA1 or plasma glucose. We conclude that oral xamoterol raises supine systolic blood pressure but paradoxically lowers standing systolic blood pressure further in insulin dependent diabetes mellitus, Xamoterol is unlikely to be of value in the management of postural hypotension in diabetic patients with autonomic neuropathy.
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  • 9
    ISSN: 1619-1560
    Keywords: Non-invasive blood pressure measurement ; Tilting
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Three non-invasive instruments were used to measure blood pressure in the supine position and on tilting—a conventional and a random-zero sphygmomanometer, and an oscillometric device (Accutorr 1A). Twenty normotensives volunteered for the study. There was no statistically significant difference in systolic blood pressure and diastolic blood pressure measured by the conventional and random-zero sphygmomanometers in the supine position. There was a difference between these recordings and those of the Accutorr, with the Accutorr giving higher readings of systolic blood pressure (p 〈 0.001, analysis of variance, 95% confidence interval of the difference between the Accutorr and the random-zero was 5.1–15.7 mmHg) and lower readings of diastolic blood pressure (p 〈 0.0001, analysis of variance, 95% confidence interval of the difference between the Accutorr and the random-zero was −12.2–−2.2 mmHg). On tilting, the Accutorr showed an increase in systolic blood pressure while the other two machines did not (p 〈 0.01, analysis of variance). By contrast, the Accutorr detected a smaller rise in diastolic blood pressure than with the other two instruments (p 〈 0.05, analysis of variance). The difference between blood pressure measurements made in the supine position by the two different techniques, auscultation and oscillometry, might be expected. However, the two different techniques do not detect the same blood pressure responses to a change in posture.
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  • 10
    ISSN: 1619-1560
    Keywords: Man ; Dogs ; Liver ; Hepatic artery ; Portal system ; Sympathetic nervous system
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The sympathetic innervation of human and dog livers was examined by immunohistochemical localization of neuron-specific enolase to visualize the total complement of hepatic nerves and the localization of two enzymes involved in catecholamine synthesis, tyrosine hydroxylase and dihydroxyphenylalanine decarboxylase, to visualize sympathetic nerves. Similar results were obtained for both man and dog. About 60% of the non-myelinated axons supplying the hepatic parenchyma, and virtually all those supplying the vasculature, appeared to be sympathetic. The pattern of dihydroxyphenylalanine decarboxylase immunoreactivity was compatible with innervation of the intrahepatic hepatic arteries and portal veins by dopaminergic as well as by noradrenergic sympathetic nerves. By contrast, there was no evidence for a dopaminergic component in the parenchymal sympathetic innervation.
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