301
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Hughes SJ, Short DJ, Usherwood MM, Tebbutt H. Management of the pregnant woman with spinal cord injuries. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1991; 98:513-8. [PMID: 1873238 DOI: 10.1111/j.1471-0528.1991.tb10361.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This paper forms part of an ongoing prospective study of pregnancy and labour in women with spinal cord injuries and combines a prospective and retrospective analysis of 17 pregnancies in 15 women with spinal injuries. The management and outcome in those 17 pregnancies is reviewed.
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302
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Nusser J, Landgraf R. [Significance and diagnosis of autonomic neuropathy in diabetes]. FORTSCHRITTE DER MEDIZIN 1990; 108:674-7. [PMID: 2276709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The results of studies performed to date would appear to show that autonomic neuropathy (ANP) in diabetics can involve any organ system. The earliest and most common manifestation is seen in the cardiovascular system, and finds expression as orthostatic phenomena, resting tachycardia, and "rigid pulse". Simple, non-invasive tests permit accurate quantification and follow-up. ANP in the gastrointestinal tract manifests as a motility disturbance, and the resulting delay in absorption might be the cause of inexplicable blood sugar fluctuations. A phenomenon of decisive importance for the diabetic is the lowering of his awareness of a hypoglycemic state. For this reason, intensive training of the diabetic in the self-determination of blood sugar and requirement-matched insulin dosage are thus of extreme importance. Disturbances of sexual function, which are all too rarely mentioned, usually put a heavy strain on the diabetic. Medical care of diabetics prior to, during and after surgery should give due consideration to cardiac, pulmonary and gastrointestinal ANP involvement. In view of the limited therapeutic possibilities, prevention of ANP should receive top priority.
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303
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Moiseeva NI, Komarova NN, Nikitina LN, Ponedelko RP. [A chronotherapeutic approach to prescribing medical physical exercise]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 1990:42-4. [PMID: 2077736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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304
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Bannister R. The diagnosis and treatment of autonomic failure. JOURNAL OF THE AUTONOMIC NERVOUS SYSTEM 1990; 30 Suppl:S19-23. [PMID: 2212487 DOI: 10.1016/0165-1838(90)90095-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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305
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Morozov AM, Gorbov VG. [The treatment of sexual disorders in men with autonomic dystonia]. VRACHEBNOE DELO 1990:95-7. [PMID: 2238613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Results are reported of a study of 55 males with disorders of sexual potency with an objectively registered manifestation of vegetative dystonia. It was shown that sexual disorders in these patients have a psychogenic character. All of them showed neurosis and neurosis-like symptoms. With the purpose of finding effective treatment psychotherapy, phallic stimulation and physiotherapy were tried. Most effective was individual psychotherapy with elements of hypnotic suggestion and phallic vascular stimulation by local negative pressure.
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306
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307
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Haslbeck M. [Treatment of diabetic gastroparesis]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 1990; 28 Suppl 1:39-42; discussion 47-8. [PMID: 2192506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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308
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Pankova OF. [Autonomic crises in neurological disorders]. MEDITSINSKAIA SESTRA 1989; 48:27-30. [PMID: 2615616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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309
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Wright DK, Lalloo UG, Nayiager S, Govender P. Autonomic nervous system dysfunction in severe tetanus: current perspectives. Crit Care Med 1989; 17:371-5. [PMID: 2649313 DOI: 10.1097/00003246-198904000-00015] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The enigma of autonomic nervous system dysfunction in severe tetanus is discussed in the light of recent and older evidence concerning the nature and action of tetanus toxin, its clinical effects, and therapy. Some suggestions for the pathogenesis and management of the cardiovascular disturbances are made.
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310
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Oliva J, Iñíguez N, Pifarre G, Rueda D. [Diabetic somatic neuropathy]. Aten Primaria 1989; 6:183-7. [PMID: 2518917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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311
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Das AK. Diabetic heart disease--current problems and their management. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 1989; 37:163-5. [PMID: 2681139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Diabetic heart disease (DHD) is one of the most important contemporary management problems confronting the entire diabetic management team. DHD is multifactorial and multifaceted. The three major problems are: coronary artery disease (CAD), autonomic cardiac denervation and a specific heart muscle disease in diabetes (diabetic cardiomyopathy). Various other ancillary problems include obesity, hypertension, lipid aberrations and rheological alterations etc. CAD and diabetes mellitus (DM) have a greater association; the disease is more severe, sets in early and has many atypical features including painless, silent onset, delayed arrival at intensive coronary care unit, increased incidence of pump failure and arrhythmias and high case fatality rate. Autonomic cardiac denervation is an important and a common companion of diabetic peripheral neuropathy and has serious repercussions in DHD. Simple, sensitive screening tests may identify such a group so as to exercise caution in management. Various clinical (non-invasive, invasive and autopsy) and experimental studies provide evidence for the existence of a specific diabetic heart muscle disease comprising of small vessel disease and metabolic aberrations. Recent advances in literature and our own experience are reviewed. The practical management aspects of each facet, such as maintenance of high index of suspicion, early diagnosis and referral, close monitoring, role of rigid blood glucose control and specific role of each member of the diabetic team is outlined. The possible preventative strategies are discussed.
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312
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Kolosova OA. [The autonomic dystonia syndrome]. FEL'DSHER I AKUSHERKA 1988; 53:30-4. [PMID: 3220135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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313
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Agte BS, Dzhodzhua AG. [Bioregulation problems in the treatment of patients with autonomic vascular dystonia]. VRACHEBNOE DELO 1988:32-4. [PMID: 3212991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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314
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Brian JE, Clark RB, Quirk JG. Autonomic hyperreflexia, cesarean section and anesthesia. A case report. THE JOURNAL OF REPRODUCTIVE MEDICINE 1988; 33:645-8. [PMID: 3172064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Autonomic hyperreflexia, a potentially life-threatening condition, can appear during labor, delivery or cesarean section in a woman with a spinal cord injury. A case of autonomic hyperreflexia in a parturient was managed with regional neural blockade.
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315
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Abstract
Neurogenic tumors of the thorax are observed in all age groups, although they are rare in the elderly. They are more likely to be malignant in the child than in the adult. Tumors of the autonomic system are common in children, whereas the nerve sheath tumors are more likely to be found in adults. The malignant lesions are almost always symptomatic and the benign lesions asymptomatic, except in the child, in whom a benign lesion may result in symptoms because of its size relative to the volume of the child's thorax. Intraspinal canal extension, although relatively infrequent, should be sought for in all paravertebral tumors, for a significant percentage of these may be initially asymptomatic. Excision of such an hourglass tumor without foreknowledge of such extension may lead to serious spinal cord complications. Surgical excision of most of these tumors is sufficient except for the malignant lesions, especially in infancy and childhood, for which the addition of postoperative irradiation and chemotherapy may be beneficial. The prognosis after the removal of benign neurogenic tumors of the thorax is excellent. In the infant or child with Stage III or IV neuroblastoma, ganglioneuroblastoma, or an Askin tumor, the prognosis is poor. In the adult with a malignant neurogenic sarcoma or a malignant paraganglioma, the prognosis likewise is grave.
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316
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Wanner MB, Rageth CJ, Zäch GA. Pregnancy and autonomic hyperreflexia in patients with spinal cord lesions. PARAPLEGIA 1987; 25:482-90. [PMID: 3324019 DOI: 10.1038/sc.1987.81] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Symptoms of autonomic hyperreflexia in patients with complete and incomplete paraplegia above D 7 can be caused by almost any stimulus in the abdominal area or in the lower extremities, specifically during parturition by the uterine contractions. The symptoms vary from pilo-erection and outbreaks of sweating to serious blood pressure crises and cerebrovascular accidents. Epidural anaesthesia and general anaesthesia are effective as therapy and also as prophylaxis. Frequent complications are anemia and urinary tract infections. Changes in bladder function as a result of pregnancy and childbirth were observed. Paraplegic expectant mothers experience premature labour pains more frequently than do others, and this implies the necessity for earlier clinical surveillance up to the time of delivery. The secondary uterine inertia frequently requires an operative termination of the birth. The perception of labour pains is clearly possible also with lesions above D 10.
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317
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Davis RF, Jones LC, Hungerford DS. The effect of sympathectomy on blood flow in bone. Regional distribution and effect over time. J Bone Joint Surg Am 1987; 69:1384-90. [PMID: 3440796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Considerable interest has developed in the role of the autonomic nervous system and its effect on blood flow in bone. Theories pertaining to the long-term physiological effect of sympathectomy on blood flow in bone have been controversial. This study employed the radioactive tracer-microsphere technique to investigate the influence of sympathectomy on regional blood flow in bone over time in dogs. Blood flow was measured in fifteen adult dogs, weighing eighteen to twenty kilograms, at one hour, one day, and one, two, three, four, and six weeks after a transperitoneal sympathectomy from the first to the sixth lumbar level. Absolute control flow values were consistent with those that have been reported previously and had lower standard errors. Blood flow in bone in the femoral regions increased by 24.0 to 41.0 per cent. Greater elevations, of 37.0 to 59.0 per cent, were noted in the tibial sections. The largest increases (58.0 to 67.0 per cent) were seen in the metatarsals and proximal phalanges. All elevated values for blood flow returned to control values by six weeks. The data support the hypothesis that surgical sympathectomy exerts a significant yet transient effect on blood flow in bone. Furthermore, the greater increase distally is the first physiological evidence to support previous anatomical work that concluded that the major site of sympathetic tone lies distally in the lower extremity of the dog.
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318
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Solders G, Wilczek H, Gunnarsson R, Tydén G, Persson A, Groth CG. Effects of combined pancreatic and renal transplantation on diabetic neuropathy: a two-year follow-up study. Lancet 1987; 2:1232-5. [PMID: 2890854 DOI: 10.1016/s0140-6736(87)91851-4] [Citation(s) in RCA: 85] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
To investigate whether diabetic neuropathy can be reversed after pancreatic transplantation 13 diabetic patients were examined by means of conventional electroneurography and tests on autonomic function before and 6, 12, and 24 months after combined renal and pancreatic transplantation. 15 diabetic patients receiving a kidney graft only and 15 non-diabetic kidney graft recipients served as controls. Before transplantation neuropathy was most advanced in the two diabetic groups. Both diabetic groups showed a similar slight but significant improvement of nerve conduction after transplantation. In the non-diabetic group nerve conduction became essentially normal. No group showed improvement in autonomic dysfunction. The improvement in nerve conduction after combined kidney and pancreas transplantation was most probably due to the elimination of uraemia. Furthermore, 2 years of normoglycaemia did not reverse the diabetic neuropathy to an important extent at this late stage of the disease.
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319
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Mathias CJ. Autonomic dysfunction. Br J Hosp Med (Lond) 1987; 38:238-43. [PMID: 2823944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The autonomic nervous system is closely involved in the majority of bodily functions. Different disease processes and a variety of drugs can result in autonomic dysfunction, some with minor but others with major consequences. This review considers factors which relate to the recognition, investigation and principles of management of such disorders.
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320
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Kisliakov LA, Komarov AP. [Management of autonomic vascular dystonic crises by using the Lenar apparatus]. FEL'DSHER I AKUSHERKA 1987; 52:35-8. [PMID: 3500875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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321
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Brown MJ. The measurement of autonomic function in clinical practice. JOURNAL OF THE ROYAL COLLEGE OF PHYSICIANS OF LONDON 1987; 21:206-9. [PMID: 3302235 PMCID: PMC5379345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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322
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McLeod JG, Tuck RR. Disorders of the autonomic nervous system: Part 2. Investigation and treatment. Ann Neurol 1987; 21:519-29. [PMID: 3300519 DOI: 10.1002/ana.410210602] [Citation(s) in RCA: 124] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Autonomic function may be adequately tested with noninvasive tests of sympathetic and parasympathetic pathways, including: the response of blood pressure to change in posture and isometric contraction, heart rate response to standing, variation in heart rate with respiration, Valsalva ratio, sweat tests, and plasma noradrenaline measurements. Abnormal results in two or more of these tests indicate autonomic dysfunction. Intraarterial catheterization and tests of vasomotor function are usually required only in doubtful cases or for research purposes. Treatment of autonomic dysfunction is focused primarily on bladder control and control of orthostatic hypotension. Orthostatic hypotension is best treated with physical measures, pharmacologically with 9-alpha-fluorohydrocortisone and dihydroergotamine mesylate. A number of other agents may be tried but results have been less effective.
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323
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Sugimoto H, Shibuya M, Uenishi M, Yokota J, Terai C, Shimazu T, Megawa T, Yoshioka T, Sugimoto T. Long-term continuous spinal anesthesia in severe tetanus with autonomic disturbance. KLINISCHE WOCHENSCHRIFT 1987; 65:238-43. [PMID: 3573682 DOI: 10.1007/bf01715855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The mortality rate from tetanus is still high if the disease is accompanied by signs of autonomic nervous system dysfunction. We treated a 75-year-old woman with tetanus and autonomic dysfunction with continuous high spinal anesthesia for 23 days. She recovered. Spinal anesthesia may be a useful adjunct for the treatment of severe tetanus.
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324
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Nishimoto T, Ishikawa T, Matsumoto K, Fujioka A. Efficacy of acupuncture treatment in autonomic ataxia. THE AMERICAN JOURNAL OF CHINESE MEDICINE 1987; 15:133-8. [PMID: 3425571 DOI: 10.1142/s0192415x87000175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Recently Coefficient Variation of R-R interval derived from patient's ECG is advocated to be an objective and quantitative method of analyzing autonomic nerve function. In the present study, we used this method to make an evaluation of the acupuncture treatment on the patients suffering from autonomic ataxia. Twenty-one patients were admitted to this therapy according to the results of CMI (Cornell Medical Index) test. (4 males, 17 females, mean age was 49.9 y.o.) ECG machine was used to measure the R-R interval every 100 heart beats before and after the treatment, and through this survey, the mean R-R interval (mR-R) and Coefficient Variation (C.V. SD/mR-R x 100%) were obtained. Subjective complaints were obtained at the same time, too. The mR-R became extended in 14 out of 21 patients after treatment and mean value of mR-Rs after treatment was significantly increased than prior to treatment. (871.6 msec-before 918.3 msec-after p less than 0.05) As for C.V. the mean value was not markedly changed but the variance was decreased significantly (1.67-before 0.47-after p less than 0.025), and 60% of subjective complaints were improved after treatment. These results suggest that acupuncture therapy is effective on the patients who have been diagnosed as having autonomic ataxia by regulating autonomic nerve function.
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325
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Steptoe P, Fogh B. [The autonomic hyperactivity syndrome in tetanus]. Ugeskr Laeger 1986; 148:2905-7. [PMID: 3787829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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